Does Medicaid Pay For Weight Loss Surgery?

Last Updated on January 29, 2024 by Lori Pace

Does Medicaid Pay For Weight Loss Surgery? The answer is yes! However, there will be some criteria and information that you need to know. And we will cover it for you in this article!

Getting Medicaid to Pay for Weight Loss Surgery

How do you get Medicaid to cover weight loss surgery? Obesity is a severe problem in America. The issues often lead to diabetes, high blood pressure (HBP) and other cardiovascular diseases. As shown below, Medicaid has made it a point to pay for weight-loss surgeries.

Getting Medicaid To Pay For Weight Loss Surgery
What Is Weight Loss Surgery?

What Is Weight Loss Surgery? It’s a procedure to lose weight and can improve your digestive system.

What’s The Process of Weight Loss Surgery Approval by Medicaid?

To be eligible for weight loss surgery under your state Medicaid, you need to schedule a meeting with a doctor. The surgeon will discuss all aspects of your options and go over the details.

After you make a decision, your surgeon will run several tests to assess your medical condition. Apply for pre-approval from state Medicaid once the doctor is satisfied with the results. You should be patient as the entire process can take a while. If Medicaid approves an operation, the doctor will need to confirm that you are ready to have surgery. This may include a blood test, x-rays and other preparations.

It can be challenging to determine which portion of your operation will have Medicaid coverage in your state. So, you can check with the local Medicaid office to confirm that this information is available. However, these procedures are expensive. And it’s best to continue reading to learn more about which bariatric procedures are under Medicaid coverage. Besides, what criteria are used for enrollees who need weight-loss surgery.

What are Medicaid’s Criteria for Weight Loss Surgery Coverage?

So, you must meet these requirements for Medicaid to cover your bariatric surgery.

  1. Females must be over 13 years old, and males must be over 15 years old.
  2. If you are under 21 years old, your BMI or body mass index should be above 40. If you’re over 21 year old it should be over 35.
  3. A letter from your primary doctor indicating that weight loss surgery is a .
  4. Pass in a psychological exam.
  5. You can prove that you tried normal treatment to manage your comorbidities but failed. High cholesterol, sleep apnea and HBP are all possible comorbidities.
  6. Proof of being a part of a clinically controlled weight-loss program for half the year. This was one year before your surgery.
  7. Also, after the weight loss surgery , you must affirm that you will be changing your routine and diet.

What Can Disqualify You from Medicaid’s Weight Loss Surgery Coverage?

  1. Non-compliance with previous medical treatments.
  2. Conditions like pregnancy, chronic pancreatitis, and inflammatory bowel disease
  3. Psychological treatment can interfere with diet and routines after surgery.
  4. Malignant cancer.
  5. Steroid use for long-term.

Which Other Medicaid Considerations Are Required?

Medicaid will not pay for weight loss surgery if it is to be performed in a hospital with the Bariatric Center for Excellence accreditation. So, this certification shows you which Medicaid has approved hospitals to perform weight loss surgery.

To ensure you receive the best treatment, Medicaid requires you to visit one of these facilities. You can lose weight with many different operations, but Medicaid covers only the most common.

Let’s say you are looking for a different type of bariatric surgery to replace gastric bypass, gastric sleeves, or lap band revision. You will either need to obtain a different type of insurance or pay directly out of your own pocket for the surgery.

Which Weight Loss Surgeries Does Medicaid Cover?

Which Weight Loss Surgeries Does Medicaid Cover

Gastric Bypass

A type of weight loss surgery that involves the operation on your stomach and small intestines in order to change how they absorb and digest food.

Gastric bypass allows weight loss through:

  • Firstly, lessen the food your stomach can take
  • Then, limits your small intestine in absorbing nutrients and calories
  • And the transformation of your digestive hormones helps suppress your appetite and keep you fuller longer

Lap Band Revision

A procedure that involves using a silicone band to adjust the size of your stomach. This creates a small section above the band and the rest below it. In short, this restricts the amount of food and beverages you can consume in a single sitting.

Of course, the procedure can be reversed. And the band can be adjusted. The laparoscopic procedure for changing the lap band is not as intrusive as other gut procedures.

Gastric Sleeve

Vertical sleeve gastrectomy is a type of weight loss surgery that removes approximately 75% of your stomach. Hence, this is the most popular bariatric procedure in America today.

Medicaid coverage does not cover all of your needs. The following are what you need to pay for:

  • Co-payments: This is a fixed amount that you pay for certain checkups. This applies normally to prescription medication for Medicaid.
  • Deductibles: This is the annual sum you pay to an insurer for a certain time period before they start covering all your procedures and checkups.
  • Co-insurance: This is a portion of the treatment costs that you are responsible for paying.

Final Thought

Medicaid’s requirements regarding weight loss surgery or bariatric procedures are slightly different from other US insurance providers. They’re very specific in how they cover people and who they cover. There are many qualifications that Medicaid must meet in order to cover your surgery.

However, if Medicaid does not cover your case, you can consider Medicare coverage or even apply for Grants to support your weight-loss surgeries.

Lori Pace
Lori Pace

Lori Pace is a single mother of three daughters ages 7 and under. As a working mom from home, she balances kids, work and two crazy dogs with humor and love. Follow Lori as she honestly gives tips and advice based on her own experiences as a single mom!