Approximately 1 in 3 U.S. adults and 1 in 6 children and adolescents are obese. Medicaid and the Children's Health Insurance Program (CHIP) can play a role in reducing the rate of obesity in the United States by improving access to health care services that support healthy weight. 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 Affordable Care Act Improves Prevention and Obesity Coverage
The Affordable Care Act includes several provisions that promote preventive care including obesity-related services and coverage.
- These provisions include an enhanced federal match for states that cover all U.S. Preventive Services Task Force (USPSTF) grade A and B recommended preventive services and ACIP recommended vaccines and their administration with no cost-sharing. Obesity screening and counseling for children, adolescents and adults is a USPSTF recommended service.
- The law calls for states to design public awareness campaigns to educate Medicaid enrollees on the availability and coverage of preventive services, including obesity-related services. To help states meet this requirement, CMS will host calls and webinars regarding coverage and promotion of preventive services, develop fact sheets that address Medicaid coverage of preventive services, and share examples of state Medicaid program efforts to increase awareness of preventive services.
- Qs & As on ACA Section 4004(i) "Requirements Related to Preventive Services and Obesity-Related Services"
- Preventive and Obesity-Related Services Available to Medicaid Enrollees (Report to Congress)
- The ACA provided funding for the Childhood Obesity Demonstration Project. The Children's Health Insurance Program Reauthorization Act (CHIPRA) established this obesity demonstration grant program to identify effective health care and community strategies to support children's healthy eating and active living to help combat childhood obesity. The project targets low-income children aged 2-12 years. The Centers for Disease Control and Prevention (CDC) leads this program and is working with the Centers for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH).
For more information and guidance about prevention-related provisions in the Affordable Care Act, visit the Prevention Provisions page.
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. Several states are working with their managed care organizations to implement performance improvement projects focused on body-mass index screening and referral for healthy weight and physical activity counseling.
To share information about state Medicaid and CHIP efforts to improve awareness and effectiveness of obesity-related services, email MedicaidCHIPPrevention@cms.hhs.gov.
Collaborate for Healthy Weight brings primary care providers, public health professionals, and leaders of community-based organizations together to use quality improvement methods to reverse the obesity epidemic in communities across the country. It is a project of the National Initiatives for Children's Healthcare and Quality (NICHQ) and the Health Resources and Services Administration (HRSA).
Overweight and Obesity – Centers for Disease Control and Prevention
The Guide to Community Preventive Services – Centers for Disease Control and Prevention
Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation – Institute of Medicine Report
Chronic Disease and Obesity Prevention – Association of State and Territorial Health Officials (ASTHO)
Obesity Issues, Reports and Resources – Trust for America's Health
Questions about Medicaid and CHIP coverage of preventive and obesity-related health care services can be directed to: MedicaidCHIPPrevention@cms.hhs.gov.