Medicaid Eating Disorder Coverage

Eating disorders can affect anyone, regardless of their age, sex, race, body weight—or health insurance policy.

These conditions can be dangerous or even deadly if left untreated. But treatment is also often expensive, and finding the appropriate coverage to support your recovery can be tricky.

If you use Medicaid health insurance, you may have additional questions about how and whether your policy will cover treatment for eating disorders.

Does Medicaid Cover Eating Disorder Treatment?

Medicaid can help you pay for certain types of eating disorder treatment, including therapy. However, there are limitations to what the policy will cover. Additionally, policy holders must meet certain requirements in order to be eligible for coverage.

By law, Medicaid must provide the same coverage for mental health conditions as any other medical condition. [1]

Medicaid is the leading payer for mental health services in the United States. The organization is playing an increasingly significant role when it comes to reimbursement of mental health services.

To find out more about how you can use Medicaid eating disorder coverage for your treatment, you can visit a Medicaid Health Home or a treatment center that accepts Medicaid, consult your policy, or contact a representative at the organization.

What Will Medicaid Cover?

All state Medicaid programs cover mental health conditions, including eating disorders. Though the types of treatments available for coverage may vary.

Beneficiaries of the Children’s Health Insurance Program (CHIP), including kids and teens, receive essential mental and behavioral health coverage. On the other hand, coverage for adults is determined on a state-by-state basis. [2]

Medicaid

Types of Eating Disorders Covered by Medicaid

As eating disorders are considered mental health conditions, they fall under Medicaid’s extensive mental health coverage.

Through this program, you may receive treatment for: [3, 4, 5]

Again, the types of therapies and treatments available for these conditions vary by state. Contact a Medicaid representative or consult your policy for more information.

Levels of Care Covered by Medicaid

Medicaid health insurance can be used to cover all levels of care for eating disorders, including inpatient, residential, partial hospitalization, and outpatient treatment.

However, patients are usually required to seek outpatient treatment first before moving on to more intensive levels of care. [6] Some exceptions, including medical emergencies, are possible.

For more information, contact a Medicaid representative.

Types of Treatment Covered by Medicaid

Medicaid covers a suite of treatments and therapies under its mental health coverage, including: [7]

It’s also important to note that there are limitations on the lengths of therapy and treatment programs covered under Medicaid.

What Does Medicaid Not Cover?

Medicaid only covers treatments that meet its definitions of medically reasonable and necessary care. Anything that falls outside these designations will not be covered. [7]

“Medically necessary” refers to research-based treatments that have showcased results in the past. This includes health care services and supplies required to diagnose or treat eating disorders. Medicaid will not cover anything that does not meet accepted standards of medicine.

It’s also important to note that Medicaid eating disorder coverage does not extend to private nursing or services provided by a household member. In most instances, it will also not cover things like bandages, adult diapers, and other disposables, should they be required for the treatment of eating disorders. [8]

What are Medicaid Health Homes?

Medicaid Health Homes are government-run treatment centers that offer services for Medicaid recipients. They offer programs for several conditions, including eating disorders.

There are generally several Medicaid health homes in each state. The Centers for Medicare & Medicaid Services has more information.

Other Treatment Centers that Accept Medicaid

Aside from Medicaid Health Homes, many hospitals and rehab centers accept Medicaid eating disorder insurance for the treatment of eating disorders.

When researching treatment centers or programs you may be interested in, make sure to ask whether they accept Medicaid.

Healthcare

How to Start the Treatment Process Using Medicaid

Generally, the first step toward receiving health insurance coverage for an eating disorder is getting an official diagnosis. This will not only help insurance companies understand the severity of the condition, but help treatment centers determine the type and level of care you may need.

Once you have an official diagnosis, you can contact Medicaid and request a case manager. Your case manager will help you locate an appropriate treatment center and make the appropriate arrangements to begin receiving covered care. Your case manager will be a great source of help and advice for navigating the process of receiving treatment and ensuring your care is covered by Medicaid.

People with eating disorders can experience physical and emotional health consequences, which usually become more severe over time without treatment. Some of the complications include electrolyte imbalance, organ damage, and even death.

This is why it’s crucial to find help for an eating disorder regardless of your insurance status. It is important to remember that recovery is possible and that you are not alone in your journey. With the right support, you can get the help you need to manage your disorder and create a healthier lifestyle.

The best way to find eating disorder treatment centers that accept Medicaid is to contact your state’s Medicaid office. They should have a list of approved providers and can provide details on locations and services. Additionally, you can contact your local hospital or health department for more information on resources in your area.

Resources

  1. The Mental Health Parity and Addiction Equity Act (MHPAEA). Centers for Medicare & Medicaid Services. Accessed January 2023.
  2. Health Insurance and Mental Health Services. MentalHealth.gov. Accessed January 2023.
  3. ICD-10-CM/PCS MS-DRG v39.1 Definitions Manual. Centers for Medicare & Medicaid Services. Accessed January 2023.
  4. ICD-10-CM/PCS MS-DRG v35.0 Definitions Manual. Centers for Medicare & Medicaid Services. Accessed January 2023.
  5. DRG 883 Disorders of Personality and Impulse Control. Centers for Medicare & Medicaid Services. Accessed January 2023.
  6. Does Insurance Cover Eating Disorder Treatment & Therapy? Athena Care. Accessed January 2023.
  7. Psychiatric Diagnostic Evaluation and Psychotherapy Services. Centers for Medicare & Medicaid Services. Accessed January 2023.
  8. Worstell, C. (2022, October 26). What Does Medicaid Cover and Not Cover? Medicare Advantage. Accessed January 2023.

Published on April 28, 2023. Published on EatingDisorderHope.com