Analysis Shows Existing Medicaid Benefit Codes Cover Childhood Obesity-Related Health Care Treatment

Study of state Medicaid payment practices related to preventing obesity

From 2004 to 2005, researchers at George Washington University (GWU) School of Public Health and Health Services analyzed whether health insurance-especially Medicaid-could cover preventive health services for children at risk for obesity.

From 2005 to 2006, researchers at the GWU Center for Health Services Research and Policy looked at whether insurers' coverage and payment practices, especially those of state Medicaid programs, supported recommended clinical practice.

Key Findings

  • Medicaid, under its Early & Periodic Screening & Diagnostic Treatment (EPSDT) benefit, can cover comprehensive, obesity-related pediatric health care services. No new legislation or guidance is needed. (ID# 052240)

  • Every service needed to provide quality childhood obesity prevention services according to clinical guidelines in use as of 2005 has an existing code for provider reimbursement. No new codes are needed. (ID# 053842)

  • Most state Medicaid manuals do not provide clear or adequate information about coverage levels and appropriate reimbursement codes for specific elements of care. Providers, therefore, remain uncertain about which services they can provide and if they can be reimbursed. (ID# 053842)