Coverage of Obesity Treatment: A State-by-State Analysis of Medicaid and State Insurance Laws
Coverage of Obesity Treatment: A State-by-State Analysis of Medicaid and State Insurance Laws
复制标题
DOI：
10.1177/003335491012500415
复制
发表时间：
2010-07-01
影响因子：
3.3
通讯作者：
Rosenbaum, Sara
中科院分区：
文献类型：
--
作者：
Lee, Jennifer S.;Sheer, Jennifer L. O.;Rosenbaum, Sara
目标。我们确定了国家医疗补助计划是否涵盖成人和儿童肥胖的推荐治疗，以及国家在多大程度上规范了私人保险公司对肥胖的治疗和覆盖。我们对医疗补助手册和私人保险法律法规进行了逐个州的文件审查。8个州的医疗补助计划似乎涵盖了所有推荐的成人肥胖治疗方式。只有10个州对儿童的肥胖相关治疗进行报销。在小团体保险市场，35个州明确允许将肥胖作为调整费率的标准，而10个州在个人保险市场这样做。有两个州明确允许在个人市场的资格决定中使用肥胖。五个州在小群体和个人市场提供一种或多种治疗肥胖症的覆盖。很少有州通过医疗补助或私人保险确保成人和儿童肥胖的推荐治疗覆盖范围。大多数州允许使用肥胖来调整小团体和个人市场的费率，并拒绝在个人市场上覆盖。
Objectives. We determined whether state Medicaid programs cover recommended treatments for adult and pediatric obesity and to what extent states regulate the treatment and coverage of obesity by private insurers.Methods. We conducted a state-by-state document review of Medicaid manuals and private insurance laws and regulations.Results. Eight state Medicaid programs appear to cover all recommended obesity treatment modalities for adults. Only 10 states appear to reimburse for obesity-related treatment in children. In the small-group insurance market, 35 states expressly allow obesity to be used for rate adjustments, while 10 states do so in the individual market. Two states expressly allow obesity to be used in eligibility decisions in the individual market. Five states provide for coverage of one or more treatments for obesity in both small-group and individual markets.Conclusions. Very few states ensure coverage of recommended treatments for adult and pediatric obesity through Medicaid or private insurance. Most states allow obesity to be used to adjust rates in the small-group and individual markets and to deny coverage in the individual market.