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 focusing on glucagon-like peptide 1 (GLP-1) prescription drugs approved by the FDA. 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, contingent upon a licensed physician's certification 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 all Medicaid state plan amendments (SPAs) to the Human Services Committee for approval before seeking federal approval, rather than only those previously requiring a waiver. Furthermore, it mandates that prescribing practitioners complete training in effective pain management to qualify for Medicaid reimbursement for opioid prescriptions. The fiscal implications of these changes are significant, with projected costs for weight loss drugs estimated at $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 the weight loss drug coverage effective upon passage.

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