Priority Policy

Medicare, Medicaid and CHIP

Obesity prevention and treatment for low-income Americans

Medicaid is a government-run healthcare program serving more than 67 million low-income Americans or those with disabilities. A 2018 study found that an average of 8.2 percent of Medicaid dollars go to treating obesity—with some states spending more than 20 percent of their Medicaid dollars on treating obesity and related illnesses. Other research shows that severe obesity alone costs state Medicaid programs almost $8 billion a year. For children on Medicaid, states have to cover all medically necessary screenings, and diagnostic and treatment services, which can include obesity services. For adult Medicaid participants, most states cover at least one obesity-related service such as body mass index (BMI) screenings.

Medicare is a federal healthcare program for 59 million Americans ages 65 and older. Public programs paid for approximately 41 percent of the obesity-attributable expenditures associated with severe obesity — with Medicare covering 30 percent of severe obesity-related care nationwide. Medicare now covers BMI screenings and behavioral counseling for patients with obesity and can provide coverage for bariatric surgery for select patients.

The Children’s Health Insurance Program (CHIP) covers more than 9 million children from low-income families. CHIP’s Childhood Obesity Research Demonstration (CORD 1.0) was created in 2011 to provide funding to states to implement community-based healthy eating and physical activity strategies for young children. CORD 2.0, an expansion of the original 2011 project, focuses on increasing access to obesity screening and counseling services for children eligible or enrolled in CHIP, and referring eligible children to local pediatric weight management programs.

recommendations

The following recommendations regarding Medicare, Medicaid and CHIP come from State of Obesity: Better Policies for a Healthier Future, 2018, produced by Trust for America’s Health and the Robert Wood Johnson Foundation.

• All public and private health plans should cover the full range of obesity-prevention, treatment, and management services, including nutritional counseling, medications, and behavioral health consultation.

• Medicare should encourage eligible beneficiaries to enroll in obesity counseling as a covered benefit, and evaluate its use and effectiveness. Health plans, medical schools, continuing medical education, and public health departments should raise awareness about the need and availability of these services.

• Public and private payers should cover value-based purchasing models that incorporate health outcome measures that incentivize clinicians to prioritize healthy weight.

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Investments in community-based programs save healthcare costs

A 2008 study by the Urban Institute, The New York Academy of Medicine and Trust for America’s Health found that an investment of $10 per person in proven community-based programs, such as those that increase physical activity and improve access to healthy foods, could save more than $16 billion in healthcare costs annually in the United States within five years. Of the $16 billion, Medicare could save more than $5 billion and Medicaid could save nearly $2 billion.

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clinical interventions

The Massachusetts Childhood Obesity Research Demonstration, a CORD 1.0 grantee, found that children in a community where a range of clinical obesity-reduction interventions were implemented, such as Healthy Weight clinics, pediatric weight management training, and community health worker integration, saw their body mass index decrease compared to other low-income children who received a routine doctor visit.

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Spotlight

performance improvement projects

The federal government requires that state-run Medicaid managed care programs implement performance improvement projects (PIPs), experimental initiatives designed to achieve significant sustained improvement in clinical and non-clinical care settings. In 2014-15, 13 states reported a combined total of 26 PIPs that addressed childhood obesity. While specific interventions of each PIP varied across states and managed care organizations, most of the programs included improving BMI documentation and counseling for healthier eating and physical activity.

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Fast Facts

$91.6B

A Brookings Institute study found that the federal government spends $91.6 billion annually to treat Medicaid and Medicare patients with obesity.

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<1%

In 2013, only 0.6 percent of Medicare beneficiaries accessed Medicare’s obesity coverage benefits such as BMI screenings and behavioral counseling for weight management.

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$1,980+

In 2012, Medicaid spent an additional $1,980 per beneficiary with severe obesity compared to those with a healthy BMI.

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Originally posted in August 2018.