WASHINGTON, D.C. – U.S. Representatives Jaime Herrera Beutler (R-WA) and James McGovern (D-MA) introduced the bipartisan Medical Nutrition Equity Act late last week, which would require private insurance and federal health programs such as Medicare, Medicaid, and the Children’s Health Insurance Program to provide coverage for medically necessary nutrition when it is required to prevent severe disability and death.
Currently, children and adults who are diagnosed with serious digestive or inherited metabolic disorders that prevent their bodies from processing normal food must pay out-of-pocket for medically necessary food, which can often cost four to five times as much as normal food. Their expenses are generally not covered by most health insurance plans.
Thirty-five states have already passed laws to ensure some level of coverage for medical necessary nutrition, but that coverage is highly variable and excludes all patients covered under federal programs.
“For the thousands of children and adults who suffer from digestive and inherited metabolic disorders, their lives depend on having access to medically specialized foods and vitamins. For conditions like Phenylketonuria (PKU), treatment with medical foods allows children to grow up to lead normal, productive lives. However, without treatment, patients experience severe brain damage, malnutrition, repeated hospitalizations, and may be forced to rely on residential treatment. I’m pleased to join this bipartisan bill to ensure these patients have access to medically essential foods. This is a commonsense, preventative solution that will lead to health care cost-savings, and more importantly will save lives,” Herrera Beutler said.
“Every year, thousands of children and adults are diagnosed with a serious metabolic or digestive issue that prevents them from eating normal food. Without proper treatment, they risk malnutrition, severe disability, and even death. Medically necessary nutrition is not a luxury for them – it’s a health- related necessity and it should be covered by health insurance,” McGovern said. “I’m proud to introduce this bill alongside Congresswoman Herrera Beutler, and I look forward to working with her to advocate for patients who need medically necessary foods.”
Right now, insurance companies only sometimes cover pharmaceuticals for digestive or metabolic disorders. Even when an insurance company does cover medically necessary nutrition, it usually comes with the stipulation that the formula be administered through a feeding tube. Surgery to place these tubes is expensive and can carry additional risks such as infection.
The full text of the bill is available here.