Does Medicaid Cover Weight-Loss Surgery?
Key takeaways:
While Medicaid may cover weight-loss surgery, eligibility and coverage details vary by state.
State Medicaid programs may cover gastric bypass, adjustable gastric banding, laparoscopic sleeve gastrectomy, and other weight-loss surgeries if the procedures are considered medically necessary.
You may have to meet certain requirements, such as having a minimum body mass index (BMI) and an obesity-related medical condition, for Medicaid to cover your weight-loss surgery.
Over 40% of adults in the U.S. have obesity. More than 9% live with severe obesity, which is defined as having a body mass index (BMI) of 40 or higher.
Out of all the weight-loss remedies, bariatric surgery is the treatment most commonly covered by Medicaid. The operation changes your stomach and digestive system to help you lose weight and keep it off.
Most states provide some type of bariatric surgery coverage through their Medicaid programs. You may have to meet certain requirements to get coverage, and your plan may only cover specific types of surgeries.
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Does Medicaid cover weight-loss surgery?
Medicaid is a government-sponsored health insurance program for low-income individuals and families. The federal government provides guidelines and some funding, but each state has the flexibility to manage and administer its own Medicaid program.
According to the 2022 Obesity Across America report, 48 states offer some level of Medicaid coverage for bariatric surgery. This often includes coverage for surgical procedures like gastric bypass and adjustable gastric banding. Your state program may also cover preoperative evaluations, hospital stays, and postoperative care. But you’ll likely have to meet certain medical guidelines to get coverage for weight-loss surgery.
Since eligibility requirements and coverage vary by state, you’ll need to reach out to your state Medicaid program to get a better idea of how coverage for weight-loss surgery works in your area.
Medicaid’s criteria for weight-loss surgery coverage
Criteria for weight-loss surgery coverage varies from one state Medicaid state program to the next. Requirements to get weight-loss surgery covered may include the following:
Meeting a minimum age requirement
Having a BMI of 40 or higher
Having a BMI of 35 or higher and at least one obesity-related medical condition
Seeing a healthcare professional for a comprehensive medical history and physical examination
Having documentation of attempted weight-loss control for a number of months
Seeing a healthcare professional for a psychological evaluation to rule out unmanaged mental health disorders
Not actively using drugs, alcohol, or tobacco
Being free of illness unrelated to obesity
Obesity-related medical conditions may include high blood pressure, Type 2 diabetes, sleep apnea, and heart disease.
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What weight-loss surgery will Medicaid cover?
You may also find that only specific weight-loss procedures are covered by Medicaid in your state. For example, North Carolina covers these surgeries if you meet the criteria:
Gastric bypass
Adjustable gastric banding
Biliopancreatic diversion with or without duodenal switch
Laparoscopic sleeve gastrectomy
North Carolina doesn’t cover operations like gastric wrapping or open sleeve gastrectomy.
How can you get Medicaid to cover weight-loss surgery?
Here’s a list of steps you can take to increase the chances of Medicaid covering your weight-loss surgery:
Talk with your healthcare professional. Find out whether bariatric surgery would be considered medically necessary for you and if you’re a candidate.
Review your Medicaid plan. Check your policy for details about coverage for weight-loss surgery and the requirements you have to meet to get covered.
Gather documentation. You may need a summary of the treatment provided for your condition and a description of your response to this treatment. You may also need to demonstrate that you will access postoperative surgical, nutritional, and psychological services.
Find a facility. The Centers for Medicare & Medicaid Services mandates bariatric surgery procedures must be done at facilities certified by the American College of Surgeons as a Level 1 Bariatric Surgery Center or certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence.
What other obesity services does Medicaid cover?
Medicaid and Children’s Health Insurance Programs (CHIP) programs offer coverage for screenings and interventions to reduce obesity. These tools promote healthy eating and physical activity.
Medicaid and CHIP programs may cover a range of obesity care services, including:
BMI screenings
Education and counseling on nutrition and physical activity
Prescription medications that promote weight loss
The U.S. Preventive Services Task Force (USPSTF) requires Medicaid programs to cover grade A and B services, which are services that are highly recommended for preventive care. In turn, states get an increased federal match for the services under the Affordable Care Act. Obesity screening and counseling is a grade B recommended service.
The Early and Periodic Screening, Diagnostic, and Treatment benefit is for Medicaid recipients under the age of 21. The benefit covers medically necessary services, including obesity-related services. The USPSTF advises healthcare professionals to assess obesity in children and adolescents. These screenings may start at age 6. Healthcare professionals should refer qualified patients to comprehensive, intensive behavioral interventions.
For adults, states can choose which services to include in Medicaid obesity coverage. The USPSTF suggests healthcare professionals offer behavioral interventions to adults with a BMI of 30 or higher.
The bottom line
Check with your state Medicaid program for details about coverage for weight-loss surgery and services. Most states offer some type of Medicaid coverage for bariatric surgery. You may have to meet specific criteria to get coverage for an operation, however. And your state may only offer coverage for certain types of surgery.
You may also have Medicaid coverage for obesity-related preventive screening and counseling services. Your state must cover services recommended by the U.S. Preventive Services Task Force (USPSTF). The Early and Periodic Screening, Diagnostic, and Treatment benefit covers obesity screening and counseling for children.
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References
Center for Medicare & Medicaid Services. (2006). Bariatric surgery for the treatment of morbid obesity.
Hales, C. M., et al. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017–2018. Centers for Disease Control and Prevention.
Illinois Department of Healthcare and Family Services. (n.d.). Bariatric surgery criteria.
MassHealth. (2024). Guidelines for medical necessity determination for bariatric surgery.
Medicaid.gov. (n.d.). Early and periodic screening, diagnostic, and treatment.
Medicaid.gov. (n.d.). Medicaid can cover obesity-related services, helping beneficiaries reduce the risk of chronic disease.
Medicaid.gov. (n.d.). Reducing obesity.
Michigan Department of Health and Human Services. (2023). Michigan Medicaid policy.
National Bariatric Link. (n.d.). Medicaid coverage for bariatric surgery.
South Dakota Department of Social Services. (2024). Surgical services.
Strategies to Overcome & Prevent (STOP) Obesity Alliance. (2017). Coverage for obesity treatment services: State Medicaid programs.
U.S. Preventive Services Task Force. (n.d.). Recommendations search results: Obesity.
U.S. Preventive Services Task Force. (2017). Obesity in children and adolescents: Screening.
U.S. Preventive Services Task Force. (2018). Weight loss to prevent obesity-related morbidity and mortality in adults: Behavioral interventions.
Waidmann, T. A., et al. (2022). Obesity across America: Geographic variation in disease prevalence and treatment options. Urban Institute.
