Does Medicaid Cover Nutritionist Services?
- Losing weight can help overweight individuals stave off illnesses, improve mood and feel more confident. Find out if Medicaid covers nutritionist services.
Weight loss is a goal for many people, with 42.4% of Americans considered obese and a further estimated 30% falling into the overweight category, according to the Centers for Disease Control. Obese individuals have a Body Mass Index over 30, but someone is considered overweight if they have a BMI between 25 and 29.9.
Losing weight has many health benefits and can help prevent chronic diseases, including heart disease, diabetes, cancer, stroke and hypertension. It can also help boost confidence and resolve mood issues. Medical nutrition therapy (MNT) is considered one of the best ways to improve lifestyle habits that contribute to weight loss such as diet and exercise. This article explores whether Medicaid covers the cost of working with a registered nutritionist.
Does Medicaid Cover Nutritionist Services?
Medicaid coverage for MNT varies depending on where you live, and the scope of coverage depends on a range of factors. One of Medicaid's defining characteristics is that individual benefits are governed at the state level. Although the federal government requires that providers cover specific mandatory benefits, it affords state government the choice over which optional benefits it offers beneficiaries.
Mandatory vs. Optional Benefits
For example, mandatory services include inpatient and outpatient hospital treatment, lab tests, X-rays and physician visits. Optional benefits include physical therapy, occupational therapy, case management and prescription medication. While MNT isn't expressly outlined as an optional benefit, it could fall into the category of "other diagnostic, screening, preventive and rehabilitative services."
However, some states don't currently recognize registered dietician nutritionists as approved Medicaid providers. For your Medicaid plan to potentially cover MNT under the premise of diagnostic, screening, preventive and rehabilitative services, RDNs would have to be approved by your state. Get in touch with your local Medicaid office for specific information about whether MNT is covered in your local area.
Managed Care Organizations
While the federal government doesn't necessitate Medicaid agencies to provide nutritionist services, MCOs can elect to provide them to members. MCOs are the main delivery system for Medicaid, and programs vary from state to state. Some states are in the process of implementing initiatives to provide additional care to individuals with complex and chronic conditions. Beneficiaries enrolled with MCOs might be able to get nutritional counseling through their Medicaid plan.
The Diabetes Prevention Program
The CDC has established a community-based program in partnership with private and public organizations, authorized by Congress, to help prevent or delay the onset of Type 2 diabetes. The National Diabetes Prevention Program is a lifestyle-change program, which helps people with prediabetes do the following:
- Learn how to eat a healthy, balanced diet
- Add enjoyable physical exercise to your routine
- Manage stress
- Remain motivated
- Work through issues that might prevent you from reaching your goals
If you're at risk of developing diabetes or you have prediabetes, MNT might be covered under the DPP. Per the Academy of Nutrition and Dietetics, the following states currently offer some form of Medicaid coverage for the DPP:
- New Jersey
- New York
North Carolina: Pregnant Women and Individuals Under 21
As of July 26, 2020, registered dieticians and nutritionists in North Carolina are eligible to enroll in Medicaid to offer their services to pregnant women and people aged under 21. If you're a North Carolina resident and you fall into either of these groups, there's a good chance you can claim for MNT services under Medicaid.
Should I Go See a Nutritionist to Lose Weight?
If your BMI is between 18.5 and 24.9, you don't need to see a nutritionist to lose weight. However, if your BMI is above this range and you think you need help losing weight, you should see a nutritionist. Weight loss can be very difficult because eating habits are often deeply ingrained from childhood, and there might be underlying issues contributing to you overeating. Working with a RDN is recommended because they have the most up-to-date scientific knowledge and training in helping people reach their goal weight.
Keep in mind that for some individuals, BMI doesn't accurately diagnose obesity. For example, if you lift weights and have a lot of muscle, your BMI could be high, but you might not be at an increased risk of disease. If you have a lot of lean body mass, consider using a different method of calculating your body fat percentage.
How Much Does It Cost to See a Nutritionist?
Seeing a nutritionist can be expensive, and the cost of an hour-long session with a RDN priced at approximately $100 to $200. If you're covered by health insurance, copays are usually around 10% to 20% of the total cost of the visit, making it around $10 to $40 per visit.