Quality of Care Obesity
Medicaid and the Children’s Health Insurance Program (CHIP) can play a major role in reducing the rate of obesity in the United States. Approximately 34 percent of U.S. adults and 17 percent of children and adolescents are obese. For children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers all medically necessary services which can include obesity-related services. For adults, the states can choose which services to provide, with most states choosing to cover at least one obesity treatment.
The Children's Health Insurance Program Reauthorization Act (CHIPRA) established an obesity demonstration grant program, which was funded through the Affordable Care Act, for multi-sector programs for the purpose of carrying out community based activities. While Medicaid programs cannot be grantees, they can be stakeholders. The Centers for Disease Control and Prevention (CDC) has the lead on this demonstration program, and is working closely with the Centers for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and other Departmental agencies.
The Affordable Care Act Improves Prevention and Obesity Coverage
The Affordable Care Act includes a range of provisions that seek to promote general prevention and obesity-related preventive efforts and coverage. This includes coverage of tobacco cessation services for pregnant women, requiring insurance plans to include preventive services in the benefit packages, and enhanced federal match for a state that eliminates cost-sharing requirements on preventive services that meet the U.S. Preventive Services Task Force’s guidelines for effectiveness. In addition, the law also calls for states to design public awareness campaigns to educate Medicaid enrollees on the availability and coverage of obesity and preventive services. CMS is working with states to determine what assistance states need in developing these campaigns.
State Efforts to Improve Access to Obesity Services
A number of states have efforts underway to improve awareness and use of obesity-related services by Medicaid eligible individuals, including MassHealth’s “Mass in Motion,” Missouri’s PHIT Kids (Promoting Health in Teens and Kids) weight management program, and the Texas Medicaid Child Obesity Prevention Pilot.