South Carolina Medicaid Program to Cover Sleeve Gastrectomy

Published in June/July Issue             

The South Carolina Department of Health and Human Services (SCDHHS) has announced that effective July 1, 2016, the state’s Medicaid program will expand its bariatric surgery benefit to include coverage of sleeve gastrectomy.

John D. Scott, MD

“This is a victory for patients in South Carolina, one of the last states that did not offer Medicaid coverage for sleeve gastrectomy” said John D. Scott, MD, Metabolic and Bariatric Surgery Director, University of South Carolina School of Medicine – Greenville and co-chair, ASMBS, access to care committee. “Now, the citizens of South Carolina will now have the same surgical options for obesity as federal employees, Medicare patients, and most private insurance customers.”

Dr. Scott explained that this coverage decision was made possible through the efforts of a grassroots patient letter writing campaign, urgent appeals by providers of bariatric services, and industry support.

“We believe this decision will enhance the lives of patients on South Carolina Medicaid and assist in reducing the overall medical comorbidity related to obesity in the state,”
Dr. Scott added.

In 2013, the ASMBS, along with the American Association of Clinical Endocrinologists (AACE) and The Obesity Society (TOS), updated its clinical practice guidelines to include laparoscopic sleeve gastrectomy as a primary bariatric and metabolic procedure. That same year the Centers for Medicaid and Medicare Services (CMS) began routinely covering the procedure nationwide and insurers throughout the country soon followed suit.

Medicaid is a health insurance program that pays medical bills for eligible low-income families and individuals whose income is insufficient to meet the cost of necessary medical services. The South Carolina Medicaid program, called Healthy Connections, is administered by SCDHHS and pays medical bills with state and federal tax money.

John Morton, MD

“A victory in South Carolina for greater access to obesity treatment is a victory for all of us including patients and their families, surgeons and other healthcare providers, as well as society itself. Obesity remains the biggest public health threat facing America and we need all the safest and most effect tools at our disposal to treat this devastating disease,” said John M. Morton, MD, ASMBS immediate-past president and a leader in helping to expand coverage for bariatric surgery throughout the country.