State, Medicaid Coverage For Obesity Treatments Varies Widely

February 17, 2022 - State and Medicaid coverage for obesity treatments is not uniform, despite the epidemic-level impact of the condition and the selection of tested treatment options, according to a report from the Urban Institute.

Obesity is considered a severe chronic condition in which body fat accumulation causes health risks.

Although obesity is a widespread chronic condition and is a comorbidity for some of the most expensive chronic conditions like type 2 diabetes and stroke, state Medicaid programs, Medicare, and Affordable Care Act marketplace plans have a variety of ways that they cover—or do not cover—the treatment options for this condition.

Fee-for-service Medicare mainly covers three types of care for obesity: screenings performed by a primary care provider, counseling performed by a primary care provider, and surgery. The national program also provides coverage for weight loss programs, but the program has to be prescribed as a treatment for a particular condition such as diabetes.

The Affordable Care Act’s coverage requirements are even more narrow in scope than in fee-for-service Medicare. The law states that private payers have to cover screenings and counseling under preventive care services. While payers are free to offer more comprehensive coverage beyond this stipulation, they are under no obligation to do so.

The study observed four types of obesity treatments from 2016 through 2017—screening and counseling, nutritional counseling, pharmacotherapy, and bariatric surgery. The data came mainly from the STOP Obesity Alliance at the George Washington University, CMS, and the Census Bureau’s American Community Survey. 

Of the four, pharmacotherapy had the least coverage in Medicaid programs. 

Five antiobesity medications have been approved by the US Food and Drug Administration (FDA). But even with multiple options and FDA approval, only 15 fee-for-service Medicaid programs cover antiobesity medications along with 16 state employee plans, four Medicaid managed care programs, and two state benchmark Marketplace plans.

Bariatric surgery, on the other hand, is broadly covered. Of the 50 state Medicaid programs, 48 Medicaid programs cover this treatment, as well as 23 state benchmark plans and 42 state employee plans.

Nutritional counseling coverage was present in a little over half of the fee-for-service Medicaid programs (26 programs) and slightly more prevalent among managed-care Medicaid programs (28 programs), along with 37 state benchmark plans and 13 state employee health plans.

Screening and counseling were the only treatments that were covered universally, in accordance with the Affordable Care Act.

Two out of the ten states with the highest rates of obesity have not yet expanded their Medicaid programs. In contrast, all but one state among those with the lowest rates of obesity had already expanded their Medicaid programs. Uninsurance is higher on average in the states with the highest rates of obesity (8.9 percent) compared to states with low obesity rates (6.8 percent).

The report did not shed any light on the reasons behind these differences in state coverage for obesity treatment. 

In fact, a comparison of coverage options in states with high rates of obesity with coverage options in states with low rates of obesity raised more questions than it answered. The same number of states in the top ten states with the highest obesity rates offered antiobesity medication coverage as the top ten states with the lowest obesity rates (3 states in each).

Twice as many Medicaid programs in states with low obesity rates offered coverage for nutritional counseling compared to programs in states with high obesity rates.

“The correlations between the treatments covered and the obesity rates in each state are not obvious,” the researchers found. 

“Though we can say nothing about the causal relationships between comprehensive coverage and obesity prevalence, these differences suggest states with the largest obesity burdens may not be deploying the full range of available treatment options to help reduce that burden.”