Substitute Senate Bill No. 1474 amends existing laws related to the Department of Social Services (DSS) and Medicaid coverage for obesity-related medical services. The bill introduces new definitions such as "bariatric surgery," "body mass index" (BMI), and "weight loss drugs," specifically including glucagon-like peptide 1 (GLP-1) prescription drugs approved by the FDA for weight loss. It mandates that the Commissioner of Social Services provide medical assistance for bariatric surgery and related services for Medicaid and HUSKY B beneficiaries with severe obesity, defined as a BMI greater than 40 or 35 with comorbid conditions. Additionally, the bill allows continued Medicaid coverage for beneficiaries treated with weight loss drugs even if their BMI drops below 35, provided a licensed physician certifies that their BMI would increase if the drugs were discontinued.

The bill also enhances legislative oversight by requiring the Commissioner of Social Services to submit any Medicaid state plan amendments (SPAs) to the Human Services Committee for approval before seeking federal approval. This includes a stipulation that the committee must vote on the SPAs within 30 days. Furthermore, it mandates that prescribing practitioners complete training in effective pain management to qualify for Medicaid reimbursement for opioid prescriptions, promoting the use of non-opioid alternatives. The effective date for these provisions is set for July 1, 2025, while the coverage for weight loss drugs will take effect immediately upon passage. The anticipated fiscal impact includes significant costs for weight loss drugs, projected at $55 million in FY 26 and $35 million in FY 27, alongside potential savings from the training requirements for Medicaid providers.

Statutes affected:
Raised Bill:
HS Joint Favorable:
File No. 441: