Bill > H6254

This bill authorizes the Executive Office of Health and Human Services (EOHHS) to establish comprehensive obesity treatment coverage in the Medicaid program starting July 1, 2025. The coverage will include prevention and wellness nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medications. The bill defines FDA-approved anti-obesity medication as any weight management drug approved by the U.S. Food and Drug Administration for patients with obesity. The coverage must be consistent with coverage for other medical conditions, with no more restrictive criteria than the FDA-approved indications. The Medicaid program can still use utilization management to determine medical necessity, but must apply the same standards used for other medical conditions. The bill requires EOHHS to notify enrollees and healthcare providers about the new coverage in 2025 and 2026, and authorizes the agency to seek necessary federal waivers, including a Section 1115 demonstration waiver, to implement the program. The bill aims to expand access to obesity treatments by ensuring Medicaid coverage for a comprehensive range of medical interventions to address obesity.

Budget and Finance

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