Medicaid for Gastric Sleeve

At the moment, there are just a few states that allow Medicaid for Gastric Sleeve Surgery, many states do not allow Medicaid to cover obesity or the cost of the procedure. Medicaid is a health program offered by the government that provides a health insurance to those qualified individuals whose level of income is below certain level.

The primary recipients of Medicaid are the women and children who are members of a minority group. Given the fact the incidence of obesity is very common, it is presumed that a good number of Medicaid recipients are most likely to be obese. The Medicaid program is being run by each state, and as it stands, only a small number of state programs offer Medicaid for gastric sleeve surgery.

Click here for more information about Gastric Sleeve Surgery Financing.

medicaid for gastric sleeve Medicaid for Gastric SleeveFrom February of 2006, the gastric band weight loss surgery has been covered by Medicaid as a treatment for morbid obesity. The laproscopic adjustable gastric banding (LAGB) is also another kind of gastric banding that Medicaid is able to cover, provided that certain criteria will be met and the procedure will only be done by those facilities that are Medicaid endorsed.

As a whole, the adjustable gastric banding (AGB) will be covered by Medicaid when it is medically needed, the weight loss procedure will not go beyond the patient’s need and when there is no equally effective, more traditional or less costly management available.

Previously, Medicaid for gastric sleeve surgery was not commonplace.  Only recently has Medicaid for gastric sleeve surgery become an issue due to the rising popularity of the procedure. Unfortunately, the Omnibus Budget Reconciliation Act (OBRA), enacted in the 1990s, covers only certain pharmaceuticals with the exceptions of drugs used to encourage weight gain or weight loss, among others. However, since Medicaid is run state by state, it is possible that your state does allow qualified people to get Medicaid for gastric sleeve surgery.

Medicaid for Gastric Sleeve – Coverage Guidelines

Medicaid for gastric sleeve surgery is a possibility.  Medicaid for gastric sleeve surgery may only be covered if used as a primary or a final stage surgery for Medicaid beneficiaries that have one of the following medical signs that poses a high risk for a standard bariatric procedures (like the laparoscopic adjustable gastric banding, vertical banded gastroplasty, Roux en Y gastric bypass, or the biliopancreatic diversion with or without duodenal switch):

  • Morbidly obese (BMI >50)
  • Has a history of multiple previous abdominal operations with a possible presence of intra-abdominal adhesions.
  • A presence of an inflammatory bowel disease.
  • Has hepatic cirrhosis with an elevated liver function tests.
  • Has undergone an organ transplant or the patient is currently taking an immunosuppressive therapy that is associated with the transplant operation.
  • Has a severe systemic disease.

Medicaid for Gastric Sleeve Coverage Guidelines – After 12 months

A subsequent bariatric surgery on or after the 12th month will be considered for approval only if:

  • The BMI has a reduced amount of 50kg/m2
  • The percentage of the body fat is equivalent to or less than 40%
  • Other types of bariatric surgery can now be safely carried out on the patient.
  • The patient meets the criteria for the surgery.

Procedures Not Covered by Medicaid

The following procedures are considered as experimental and investigational:

  • Medicaid for gastric sleeve surgery is not covered if it is performed as a part of the full operation to complete a biliopancreatic diversion with the duodenal switch as a part of any other coexisting bariatric or gastric surgery.
  • Mini gastric bypass
  • Loop gastric bypass
  • Bariatric surgery to treat the obesity related disease other than the type 2 diabetes, heart disease and life threatening cardiopulmonary problems.
  • Bariatric surgery performed on a non-adult
  • Removal of excess skin and fat folds, or other cosmetic procedures

Medicaid for Gastric Sleeve surgery to treat the underlying obesity is only covered on a very limited case source and the coverage for the said weight loss surgery may vary on a state by state basis.  If you are looking at ways to make the sleeve gastrectomy procedure affordable, you should investige Medicaid for gastric sleeve surgery a bit further.

There are limited surgeons who are willing to accept the Medicaid for gastric sleeve surgery as a payment. It is still advisable to check with your weight loss surgeon or your clinic first if they are a Medicaid provider, and then if you qualify for Medicaid for gastric sleeve.