Availability of nutrition services for Medicaid recipients in the northeastern United States: lack of uniformity and the positive effect of managed care.
OBJECTIVE
To evaluate third-party coverage of medical nutrition therapy for the Medicaid population, among whom obesity is a common health problem, and to compare coverage in managed care Medicaid programs with that in fee-for-service state Medicaid programs.


METHODS
Fifty-four Medicaid organizations in 14 states were surveyed by telephone and asked about their provision of nutrition counseling to members.


RESULTS
Overall, similar percentages of state Medicaid programs and Medicaid managed care organizations (MCOs) reimbursed for nutrition counseling; significantly more Medicaid MCOs reimbursed for this service for treatment of obesity alone. Analysis of Medicaid MCO responses by plan size failed to show a difference in the nutrition services offered.


CONCLUSIONS
Nutritionist consultation, an inexpensive and effective intervention for treatment of obesity, is not uniformly available to Medicaid patients. The inclusion of managed care in Medicaid has increased access to this service in the northeastern United States. We propose that all Medicaid recipients should have access to visits with a registered dietician or certified nutritionist either as part of a defined benefit structure or through a disease management program for obesity.
Tsai
Adam Gilden
AG
Division of General Internal Medicine, 1125 Blockley Hall, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. gildena@mail.med.upenn.edu
Mansukani
Sharad
S
Cucchiara
Andrew
A
Schaffer
Michael
M
D002204:Capitation Fee; D003376:Counseling; D018588:Fee-for-Service Plans; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration / Q000706:statistics & numerical data*; D009511:New England; D044623:Nutrition Therapy / Q000191:economics*; D009765:Obesity / Q000178:diet therapy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013221:State Health Plans / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States