Dive Brief:
- Citing concerns about rising co-morbidity rates associated with obesity, such as heart disease and diabetes, Mississippi state officials now say they will cover the costs of bariatric surgery for Medicaid beneficiaries.
- The state refused to cover the costs for years, pointing to safety, efficacy and cost issues, but the state's Medicaid director, David Dzielak, recently said, "We are pursuing all clinical options to reduce the co-morbidities associated with obesity."
- The state submitted an amendment to its Medicaid coverage that will need CMS approval. Coverage for the surgery is expected to start Feb. 1, 2016, with an average cost of $20,000 to $25,000.
Dive Insight:
Mississippi has ranked as the state with the highest obesity rate for ten years consecutively until last year when Arkansas pulled into first place. However, federal data puts Mississippi in first place for cardiovascular-related deaths with 250 per 1,000 residents every year and in second place for diabetes rates with over 12.5% of the population (276,000) with type 2 diabetes.
The American Society for Metabolic and Bariatric Surgery recently filed a complaint with HHS stating the 27 states that do not pay for bariatric surgery violate the Affordable Care Act's ban of denying coverage for pre-existing conditions and is discriminatory, as reported by Healthcare Dive.
Although the new coverage will increase state and federal expenditures more than $14 million a year, some providers, like Dr. Erin Cummins, director of the bariatric surgery department at Central Mississippi Medical Center in Jackson, said the coverage will save the state money. "If we can get to the root of the problem, we can get these people off the medications, which will save the state a ton of money."
Lifestyle changes are still important after bariatric surgery in order to ensure success. But obesity rates keep climbing - today's 78.6 million (34.9% of U.S. adults) obese American adults may spread to 44% of adults by 2030, according to a Robert Wood Johnson Foundation report. Perhaps Mississippi's move will encourage additional states to cover bariatric surgery costs.