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Medicaid paying for gastric bypass?

on 9/7/11 11:06 pm
Hi I was wondering if anyone that has been on SSI that has medicaid, has had gastric bypass and medicaid paid for it? I am in Mississippi and asked a year ago if MS medicaid paid for it and was told it didn't but I was wondering if your BMI is high enough or if it's a life and death situation will they go ahead and let you get it done? So I guess a better way to put the question I am trying to ask, is if anyone has lived in a state where medicaid does NOT pay for gastric bypass but has been able to get it done due to very high BMI or a life or death situation?
I just got approved for SSI after two years fighting for it and WLS is only hope for ever living a normal life again. I have several health problems which has caused my weight to get too high and along with having lymphedema that is very bad it has made it to where I can no longer walk more than a few feet to get to a from the bathroom back to the bed. I do what exercise I can while laying/sitting but being over 600 lbs now, it isn't helping much.
Celia S.
on 9/7/11 11:17 pm - Grand Junction, CO
I live in Colorado and Medicaid pays for WLS here. They only cover the band and the bypass, I believe, but they do cover it! I had to have a documented medical need for it and be more than 100 lbs overweight. I also had to jump through a few more hoops than other people might have to.

I wish I knew what to tell you about Mississippi's Medicaid rules when it comes to covering WLS ... Sorry. When you called and asked, did you ask about a specific procedure or did you ask about WLS in general?

Wishing you the best of luck!

on 9/7/11 11:22 pm - OH
I'm in Ohio and have both Medicare and Medicaid.  Medicare is my primary, Medicaid secondary.  They covered my surgery.

If Medicaid in Mississippi doesn't cover it, though, then they don't cover it.  It wouldn't matter how high your BMI is.  If they do cover it, there will be criteria you have to meet, like a BMI of 40 or above or whatever their rules are.  They won't just cover it for anyone that wants it, you have to meet the criteria.

If you have SSI, you'll be eligible for Medicare after two years.  I know that seems like a long time to wait, but they will cover WLS.  They only cover 80% of most things so you would have to pay the rest, though.

View more of my photos at          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.


on 9/7/11 11:25 pm - KY
it pays for it in ky. i think u have to have a high bmi or weight related health problems tho. i dont know why ur medicaid wont pay for yours since u are up to that weight and u want to live a better life. it should.!!! get on the phone and find out .. that way if they do. u can get started .
on 9/8/11 4:09 am, edited 9/8/11 4:10 am - Gaylord, MN
RNY on 02/13/09 with

I believe it is covered under the state Medicaid plan here in MN.  Check w/ Medicare, too.  I believe the once a person has been determined to be disabled for one year by the Social Security Administration (you are considered disabled if you are receiving SSI) they become eligible for Medicare.  The "start" date of your disability would be the date they began payment, not the date you received your first check.  That means if you received back payment for six months while you were in the midst of an appeal, your "start" date of your disability would be six months before you even received your first check.  At the point you are eligible for Medicare it becomes your primary insurance and Medicaid picks up covered services that are not paid for by Medicare.  Maybe WLS will be an option the once you hit that one year mark and become eligible for Medicare???


on 9/8/11 4:13 am
RNY on 08/15/11 with
it pays in mass
on 9/8/11 4:45 am
RNY on 09/13/11 with
I am on Medicaid in MD and i Got approved for the Surgery, But my doctor is Awesome and so is his staff, they told me what i needed and i made sure i did it...I am scheduled for 9/13/11.
(deactivated member)
on 9/8/11 5:32 am
In Nebraska Medicaid does not, we did not pay for mine, but I'm on Soc. Sec. and my Medicare did pay for mine. I had to go to a certain facility, one of Bariatric Excellence, and would only cover the band or RNY. Good luck to you!
Randajo Smith
on 9/8/11 6:21 am - Yorkville, IL
RNY on 08/16/11 with
on 9/8/11 8:08 am - MA
I also was covered and on medicaid in Mass.
on 3/29/14 12:25 pm
VSG on 11/25/14

I also live in Mass.

Did u have to do  6 months on a medically supervised diet plan? And do u know if having a BMI of 40 is enough or do u still have to have a commodity? I Have 3 commodities but 2 of them is at level 1 and controlled with meds so I don't think they will count. The other one is sleep apnea but Medicare won't recogonize (spelling?) it because I only have it in rem sleep and they say it has to be all night. If I lose more than 10 pounds I will lose a BMI of 40 and don't think I will qualify. If u can give me any info that would be great.

on 9/8/11 9:04 am
I live in Illinois and have Medicaid.  It paid for everything except my psychologist vist.  There were hardly any hoops to jump through and I got my approval pretty quickly.  You have to have one of the co morbidities which go along with obesity.  High blood pressure, sleep apnea, or diabetes.  I would think you would be cleared for the surgery and that Medicaid would pay for it.  I know that in Illinois they have to approve you if you meet the criteria.  They were sued before for not approving someone for the surgery who met the criteria. 
on 9/8/11 12:54 pm - CT
I live in CT and I am on SSI which is now medicaid for low income adults.  I called them directly because I didn't want any "surprises" as far as bills are concerned, but also to see if I was responsible for anything up front and the guy said they cover it and that I wasn't responsible for anything.
My BMI is 50-51 and have sleep apnea, so hopefully I will get approved.  I also asked my surgerons office and they take that insurance and they have all the requirements that I need to get done and so far my "last" appointment is 9/30/2011 and hopefully I will find out if I am approved before the end of October.  Hope this helps
on 9/8/11 1:27 pm - FL
 I live in Florida and have medicaid and they approved me within one month of my consultation. All i had to do was show I had documented weightloss within the past 6mos I had 5 years or more of it, show a high bmi which i had and i had high blood pressure so that helped and I needed a psych evaluation which i got the day i left the doctors office and medicaid paid for that too. I went in feb 14th to meet the doctor had surgery march 17th. I had a wonderful nurse patient coordinator who helped get my paper work submitted fast. I made sure I went and got my files from both my doctors. The one place was a walk in low income clinic so i know how they are about faxing paper work never happens so i did it myself. Be proactive and KEEP on them. I would call a medicaid rep and ask about what WLS they cover and then find a doctor oh yeah they require you have a center of excellence too. All I paid for my surgery was 3.00 co pay!!! good luck n god bless
on 9/8/11 1:39 pm
RNY on 06/08/11 with
go to the forum for your state and ask there.  You can get an answer for your state.



on 1/8/12 7:47 pm - Graham, NC
 will it pay for surgery in n.c ? if you BMI is greter than 59 and you a diabetic with other health problem too
on 1/9/12 8:58 am
does anyone know if its covered in ga i have medicare first and medicaid second
on 5/8/12 11:26 pm
Yes GA medicaid pays (Peachstate,Amerigroup) its a 6 mth process like,the insurance companies
(deactivated member)
on 10/8/14 8:28 am

If I meet criteria does that mean I'm approve

on 7/6/12 5:00 pm - Granite City, IL
Hi I have been wondering about this procedure for about one year.  Myc current weight is 238 lbs and I am 5 feet 5 in tall. I have been diagnosed with Degenerative Disk disease in my lower back.  Which means I have a crushed disk. I also have high blood pressure and take meds for that. Every month i go to the Dr. and have always gained 6 to 8lbs.  Im not asking to lose 200lbs but about 80lbs would make me who I should be.  I would like to kknow if Illinois Medicaid covers this procedure if there are medical issues involved that cause constant pain?