Bariatric surgery (weight loss surgery) is an option available to tackle obesity and provide a path to health and wellness for those who have found other treatments unsuccessful in losing weight. However, for Medi-Cal to pay for weight loss surgery, you have to qualify. In this post, we are going to list the types of weight loss surgery covered by Medi-Cal and how to qualify.
Additionally, we will provide a video explaining how each surgery procedure works.
Continue reading below to find out the weight loss surgery programs covered by California Medicaid (Medi-Cal).
What is Bariatric Surgery?
Gastric bypass and other weight-loss surgeries — known collectively as bariatric surgery —involve making changes to your digestive system to help you lose weight.
Bariatric surgery is done when diet and exercise haven’t worked or when you have serious health problems because of your weight.
However, some procedures limit how much you can eat.
Other procedures work by reducing the body’s ability to absorb nutrients. Some procedures do both.
When is Weight Loss Surgery Done?
Bariatric surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:
- Heart disease and stroke
- High blood pressure
- Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
- Sleep apnea
- Type 2 diabetes
Bariatric surgery is typically done only after you’ve tried to lose weight by improving your diet and exercise habits.
Does Medi-Cal Cover Bariatric Surgery?
Yes. However, there are requirements that have to be met for Medi-Cal to cover weight loss surgery.
In most cases, individuals covered by Medicaid services may be eligible to have some forms of bariatric surgery covered.
However, for the surgery to be approved by Medi-Cal, it needs to be deemed medically necessary.
This means that an individual’s doctor usually must exhaust all other options prior to considering bariatric surgery, and a physician will need to demonstrate that bariatric surgery is necessary in order to limit or eliminate potentially life-threatening medical conditions.
Additionally, the individual may be required to try various medications and other less-invasive options prior to surgery being considered a covered expense by Medicaid.
Types of Weight Loss Surgery Covered by Medi-Cal
There are three types of weight loss surgeries covered by Medi-Cal. They are gastric bypass, gastric sleeve surgery, and Lap-Band Surgery in most cases.
Also, these surgeries are among the most popular and are more readily accepted by Medi-Cal as being medically vital to a patient’s life in certain situations.
Here’s a brief description of each:
Gastric bypass is a procedure that essentially bypasses a part of your intestine sending food straight to the lower intestine.
This procedure also reduces the size of the stomach allowing for less food to be eaten.
In bypassing a portion of the digestive process, the body will not absorb as many calories or nutrients.
This will result in weight loss along with a smaller intake of food.
Here’s a video showing how the Gastric bypass works.
Lap-Band surgery is accomplished by placing a band made of silicon and containing balloons around the top part of the stomach.
This makes less space for holding food and makes the entrance for food going into the stomach smaller.
The procedure is done laparoscopically and is minimally invasive compared to other surgeries.
Also, the band is adjustable and the procedure is reversible.
Here’s a video showing how the lap-band surgery works.
Gastric sleeve surgery is the process of creating a smaller stomach that is shaped like a sleeve.
This gives the food a smaller space to sit in and also directs the food downward through the intestines.
This procedure reduces the amount of food that can be put into the body and is generally not considered to be reversible.
Here’s a video showing how the Gastric Sleeve surgery works.
Am I a Candidate for Weight Loss Surgery?
Your physician can best answer this question for you.
However, generally, to qualify for weight loss surgery, you must meet the following criteria established by the National Institutes of Health and the American Society for Metabolic and Bariatric Surgery.
You may qualify for weight loss surgery if you:
- Are more than 100 pounds over your ideal weight or you have a Body Mass Index (BMI) of 40 or greater, or a BMI of 35-39.9, along with two or more medical conditions such as diabetes and/or hypertension which would improve significantly with weight loss.
- Have tried and have been unable to lose weight through diet and exercise.
- Are prepared to make a lifelong commitment to dietary, exercise, and behavioral changes necessary for long-term success.
- Have no mental or behavioral disorders that may interfere with long-term weight loss success.
Summary – Weight Loss Surgery Covered by Medi-Cal
Here’s the bottom line:
First, Medi-Cal does cover weight loss surgery.
Additionally, the common procedures covered are gastric bypass, gastric sleeve, and Lap-Band Surgery.
Also, you must meet Medi-Cal weight loss surgery requirements to be approved for bariatric surgery.
Lastly, you may be required to exhaust other methods of losing weight before being approved by Medi-Cal for weight loss surgery.
We hope this post on the types of Weight Loss Surgery Covered by Medi-Cal was helpful.
If you have further questions about Medi-Cal, please let us know in the comments section below.
Be sure to check out our other articles about Medi-Cal and California Medicaid program, including: