What health problem does someone have to have to be able to have medicaid pay for a tummy tuck?

Answer 1

If you are referring to the cosmetic procedure that removes belly fat, read on at the next paragraph, if you meant internal stomach altering surgery for a morbidly obese patient read the last paragraph.

Medicaid, a means tested health insurance program for those who can't afford health care, doesn't pay for anything that's generally performed as a cosmetic procedure. For example Medicaid won't pay for othodontic work no matter how bad the teeth look, even if the teeth point so far forward the patient drools because their lips don't really close. Medicaid doesn't pay even when the orthodontic work is done as a necessary part of something they do pay for. (If an operation to repair a broken or malformed jaw requires orthodontia to move the teeth either before or after surgery, Medicaid will cover the jaw surgery, but won't cover the orthodontia. If they moved them during the jaw surgery they'd only pay a portion of the surgical bill.

So, I'd say the only way it would be covered is if you are having some other surgery performed that absolutely couldn't be completed sucessfully unless the surgeon also performed a tummy tuck at the same time. Its possible (but rare) for fat to become diseased or cancerous, so if a patient had tumours in their belly fat a procedure to excise the tumours might result in what amounted to a radical tummy tuck. A less drastic example might be that some plastic surgeons will repair small hernias at the same time as a tummy tuck. Large hernias are repaired by a general surgeon or an abdominal specialist, not a plastic surgeon. Even if a small hernia is repaired at the same time, Medicaid will probably refuse to cover any part of the bill related to the tummy tuck so its likely that the patient would end up with some of the bill.

If you're asking on behalf of someone near and dear, then if they focus on keeping the weight off consistently, the skin will gradually tighten up. This is a slow process, but it will happen a lot faster than getting Medicaid to pay for a tummy tuck.

If you meant sugrically altering the size of the stomach as a way to help a morbidly obese patient who has failed to lose weight after dietary counseling and exercise instruction, then the key word was morbid. The stomach modifying surgery has substantial short term and long term risks. The patient's weight has to be causing disease that's a large enough health threat to justify the risks from the surgery, regardless of who is paying. A 30 year old patient more than 150% of normal weight with high blood pressure, an enlarged heart, Type 2 Diabetes, and some additional organ problems who has failed to lose weight with diet and excercise coaching for example.