This bill amends Chapter 40-8 of the General Laws regarding "Medical Assistance" by introducing a new section, 40-8-33, which establishes minimum obesity coverage standards in the Medicaid program. Effective July 1, 2025, the Medicaid program will be required to provide comprehensive coverage for the treatment of obesity. This includes coverage for obesity prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medications. The bill specifies that the coverage criteria for FDA-approved anti-obesity medications cannot be more restrictive than the FDA-approved indications for those medications and must align with coverage for other illnesses in terms of deductibles, lifetime dollar limits, copayment, and coinsurance factors.

Additionally, the bill mandates that the Medicaid program must provide written notice to enrollees regarding the new coverage requirements, which must be prominently positioned in any literature or correspondence sent to enrollees and transmitted within the calendar years 2025 and 2026, but no later than their renewal date. The Medicaid program must also provide written notice to healthcare providers and prescribers about the coverage requirements, with the initial notice to be transmitted no later than October 31, 2025.

The executive office of health and human services is directed and authorized to apply for and obtain any necessary waivers, waiver amendments, and/or state plan amendments from the Secretary of the United States Department of Health and Human Services, including, but not limited to, a section 1115 demonstration waiver. The act will take effect upon passage.