How Does Medicaid Cover Obesity Treatments for Children?

August 21, 2023 - As obesity treatments become more popular, Medicaid plays a key role in facilitating access to and coverage of these services for children, according to a KFF issue brief.

Obesity can increase the risk of developing chronic diseases and is tied to physical and mental health challenges and higher healthcare costs. Child obesity rates are three times higher than they were in the 1970s, according to the CDC.

In addition to the boom of new weight-loss drugs, the American Academy of Pediatrics (AAP) released new clinical practice guidelines for evaluating and treating obesity.

Insurance coverage can help boost access to obesity screenings and treatment. Half of the children in the United States receive coverage through Medicaid, putting the program in a critical position to address child obesity.

The KFF brief assesses the share of children with obesity, how Medicaid covers obesity screening and treatment, and how recent guidance changes will impact Medicaid coverage and beneficiaries.

Researchers found that 17 percent of children ages 10 to 17 have obesity, based on 2020 and 2021 data from the National Survey of Children’s Health. Children with Medicaid (26 percent) are more than twice as likely to have obesity than those with private insurance (11.4 percent).

Additionally, Black, Hispanic, children of other races, and low-income children were more likely to have obesity compared to White children and those in households with the highest incomes. These disparities are driven by higher rates of food insecurity, limited access to physical activity opportunities, and heightened experiences of stigma and discrimination.

Obesity is typically under-reported in claims data, KFF noted. However, existing claims data can help identify the chronic health conditions accompanying obesity.

More than one-third of children with obesity (35.6 percent) had at least one other co-occurring chronic condition. The most common co-occurring chronic condition was asthma. Around 13 percent of children with an obesity diagnosis had asthma, compared to 7.3 percent without obesity.

Children with obesity (12.4 percent) were also more likely to have depression, bipolar disorder, and other depressive mood disorders compared to those without obesity (7.6 percent).

Medicaid covers obesity services for children under its Early and Periodic Screening, Diagnostic, and Treatment (ESPDT) program. States are required to cover all screening services and services necessary to treat a physical or mental health condition for children under 21.

Through EPSDT, states may also address other factors related to obesity, such as adverse childhood experiences, social determinants of health, and behavioral health. However, states may not always choose this route.

Starting in 2024, Child Core Set quality measures, which include measures related to obesity, will become mandatory, meaning states and health plans will have data on screening and counseling rates for obesity. This may lead to states and health plans encouraging more proactive screening and treatment by pediatricians.

Additionally, the new AAP guidelines may help improve the treatment of obesity and related conditions. The guidelines recommend a range of treatments, including motivational interviewing, intensive health behavior and lifestyle treatment, weight-loss medications, and referrals for weight-loss surgery evaluation.

The guidelines are not mandatory and have received some pushback due to concerns about eating disorders and side effects. States and providers may differ on what they consider medically necessary for children.

If there is an increase in obesity treatment and anti-obesity medication utilization, the Medicaid program may see higher spending.