Op-Ed: Dietitians’ services should be covered under Medicaid

Do you or anyone you know have high blood pressure, diabetes, obesity, high cholesterol, or arthritis?

Chances are the answer is yes.  And while not linked 100 percent of the time, there is one common target that physicians usually aim to treat that impact on all of these: a person’s diet and weight.

Many of these problems are managed through diet and exercise (even though medications are commonly needed).  Primary care physicians can do this, but time constraints make this tough and less comprehensive.  Enter dietitians – a group with extensive training and availability for patient-tailored one-on-one visits.

Op-ed submit bugAccess for Medicaid patients to these important members of our health care team is about to be almost non-existent starting Oct. 1 due to new regulatory guidelines set forth in Department of Social Services regulations 17b 262-994 to 17b 262-1005.

Just as the Affordable Care Act has increased access to care, we are about to take a substantial step back in the quality of the healthcare people will be able to receive.

As of Oct. 1, the State of Connecticut will no longer cover dietary counseling services for Medicaid participants at federally qualified health centers even though a 2013 gallop poll shows these populations have a substantially higher rate of all of these aforementioned chronic conditions.

With the obesity epidemic and most of our chronic disease management linked to lifestyle issues, dietitians are an essential part of the health care team.  They are key players in educating patients on a variety of dietary changes depending on the disease states and/or dietary restrictions.

Patients with pre-diabetes are able to stave off the chronic disease; those with diabetes are able to get off medications or reach their proper blood sugar level for the first time in years.

As a physician I recognize the importance of counseling patients on these changes, but this is not always feasible or as well accomplished in a 15- to 20- minute visit where there are often many other issues to discuss.  Dedicated visits with dedicated licensed dietitians help change our medical teams into medical homes and change lives for the better.

My 13-year-old patient “Danny” suffered a hip injury in part because of his weight.  After a year of several sessions with our dietician, he has lost more than 30 pounds and is at a healthy weight.  He has learned and made lifestyle changes that he will be able to use life long.

At his new weight he is also now outgoing and confident.  This would not have been possible without having dietary services covered by his insurance and he very likely would have continued to struggle with his weight and self – esteem.

We as a society need to continue our commitment toward disease prevention and quality of life improvement.  Dietitians are an essential part of this commitment.  We need to ensure they are able to continue to practice and are reimbursed here in Connecticut for all patients.

Alicia M. Dodson, MD., practices internal medicine and pediatrics in Bristol. She is a 2013 NPA Copello Health Advocacy Fellow.

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