Bill > SB5353

This bill requires health carriers and Medicaid programs to provide comprehensive coverage for obesity treatment starting January 1, 2026, including intensive health behavioral and lifestyle treatment, metabolic and bariatric surgery, and FDA-approved obesity medications. The bill mandates that coverage for obesity treatment must be equivalent to coverage for other medical conditions, meaning patients cannot be subject to more restrictive deductibles, copayments, or benefit year maximums. Health carriers and managed care organizations can still apply standard utilization management protocols to determine medical necessity, but these must be applied consistently with how they assess other medical conditions. The bill defines key terms such as "intensive health behavior and lifestyle treatment" as evidence-based interventions supporting healthy weight management, which can be delivered in-person or via telemedicine, and "FDA-approved obesity medication" as drugs specifically approved for chronic weight management in patients diagnosed with obesity. Additionally, the bill requires the state health authority to seek federal authorization to receive matching funds for these obesity treatment services by November 1, 2025. The legislation aims to improve access to comprehensive obesity treatment across health insurance plans and Medicaid programs.

Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5353&Year=2025&Initiative=false