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. The bill also allows continued Medicaid coverage for beneficiaries treated with weight loss drugs even if their BMI drops below 35, contingent upon a licensed physician's certification that their BMI would increase if the drugs were discontinued.

Additionally, the bill modifies the legislative approval process for Medicaid state plan amendments (SPAs) by requiring the DSS to submit all SPAs to the Human Services Committee for a vote within 30 days before seeking federal approval. It also mandates that prescribing practitioners complete training in effective pain management to qualify for Medicaid reimbursement for opioid prescriptions. The fiscal impact includes projected costs for weight loss drugs of at least $55 million in FY 26 and $35 million in FY 27, while potential savings may arise from the training requirements for Medicaid providers. The effective date for these provisions is set for July 1, 2025, with immediate implementation for weight loss drug coverage upon passage.

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