By Dave Ranney
KHI News Service
TOPEKA, Jan.24
Children who depend on
Medicaid
for their health care are six times more likely to be obese than children whose parents have private health insurance.
But in Kansas, Medicaid regulations discourage physicians from treating children for obesity
the doctors can treat the youngsters, but they won”t get reimbursed for it.
“If you see a Medicaid patient for obesity and code it as such, they”ll automatically deny payment,” said Dr. James Casey, co-director of the Healthy Hawks Weight Management Program at the University of Kansas Hospital.
“Medicaid doesn”t pay much to begin with but when they pay nothing, well, that makes it pretty difficult,” said Casey, a pediatric endocrinologist.
That may soon change. The
Kansas Health Policy Authority
has proposed expanding the Medicaid -billing codes to include obesity treatment for children and, when warranted, their parents.
“One of the Health Policy Authority”s vision principles is to promote a healthy lifestyle with a focus on wellness and informed use of health services over a Kansan”s life course,” said health policy authority spokeswoman Megan Ingmire.
“The obesity counseling initiative we”ve proposed embraces that vision principle, and it is vital that the Health Policy Authority provides childhood obesity counseling through Kansas Medicaid.”
The health policy authority may see it as vital, but private health insurers don”t.
“We have an exclusion for obesity in all our plans,” said Mary Beth Chambers, spokeswoman for Blue Cross Blue Shield of Kansas, the state”s largest private insurer. “We”re like Medicaid in that we cover the secondary illness diabetes, for example but not obesity itself,” she said. “But we do have some plans that offer discounts on gym memberships or nutritional counseling.”
Chambers said obesity isn”t covered as a primary diagnosis because there”s little evidence that counseling and treatment by providers result in permanent, sustained weight loss.
Even so, Ingmire said, the new policy is in keeping with the health policy authority”s mission of promoting better health by stressing preventive services.
“It”s our hope that doctors will address obesity issues earlier rather than later and not wait until
children are sicker or develop other illnesses,” she said.
The health policy authority asked for an additional $1.4 million to cover the costs of the additional visits. Gov. Kathleen Sebelius recommended about half that
$737,483
in the fiscal year 2008 budget she submitted to the Legislature.
If the Legislature approves the budget request, or increases it, the new codes are likely to take effect July 1.
In Kansas, Medicaid covers about 164,000 children. If the new codes are implemented, health policy authority officials assume that 30 percent of these children will receive “a medical therapy nutrition visit once a year.”
The proposed new treatment codes make sense to Dr. Vernon Mills, a Leavenworth pediatrician and member of the health policy authority board.
“What we do now is like not covering a woman who”s two months pregnant because she”s healthy; instead, we tell her, “Come back in five months when you”re hypertensive and you”ve been bleeding
then we”ll cover you because you”re not healthy,'” Mills said.
“We look at obesity the same way,” he said. “We wait until all these secondary illness
diabetes, hypertension
set in and then we treat those illnesses.”
The new codes, Mills said, will encourage doctors to address obesity earlier in their treatment regimen.
“The key is to get to kids early and to make them responsible,” he said. “If we get to them early and get them to take the information to heart, it works. It”s like not smoking, not drinking or not using drugs
it”s the same with obesity.”
Mills said “at least 25 percent” of
his patients are obese or overweight.
“It doesn”t start with teenagers,” he said. “I”m seeing children whose birth weight has doubled by their one-month visit
they get so much food.”
At the University of Kansas hospital, Casey said 40 percent of his patients have high cholesterol and high body fats.
“I”m talking about kids who are 6, 7, 8 . . . 10 years old,” he said. “This is scary stuff.”
Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
dranney@khi.org
or at 785-233-5443, ext. 128.