Nutrition Counseling/Medical Nutrition Therapy are eligible with Medicaid insurance for pregnant women and children and and youth through 20 years of age. According to NC Medicaid:

"Medicaid shall cover dietary evaluation and counseling for beneficiaries under 21 years of age, and NCHC shall cover dietary evaluation and consultation for beneficiaries under 19 years of age, when; there is a chronic, episodic, or acute condition for which nutrition therapy is a critical component of medical management, including any one of the following:

• a. Inappropriate growth or weight gain such as inadequate weight gain, inappropriate weight loss, underweight, obesity, inadequate linear growth, or short stature;

• b. Nutritional anemia;

• c. Eating or feeding disorders that result in a medical condition such as failure to thrive, anorexia nervosa, or bulimia nervosa;

• d. Physical conditions that have an impact on growth and feeding, such as very low birth weight, necrotizing enterocolitis, cleft palate, cerebral palsy, and neural tube defects;

• e. Chronic or prolonged infections that have a nutritional treatment component, such as HIV or hepatitis;

• f. Genetic conditions that affect growth and feeding, such as cystic fibrosis, Prader-Willi Syndrome, or Down Syndrome;

• g. Chronic medical conditions, such as cancer, chronic or congenital cardiac disease, hypertension, hyperlipidemia, gastrointestinal diseases, liver disease, pulmonary disease, malabsorption syndromes, renal disease, significant food allergies, and diseases of the immune system;

• h. Metabolic disorders such as inborn errors of metabolism (phenylketonuria (PKU), galactosemia) and endocrine disorders such as diabetes;

• i. Non-healing wounds due to chronic conditions;

• j. Acute burns over significant body surface area;

• k. Metabolic Syndrome; or

• l. Documented history of a relative of the first degree with cardiovascular disease or possessing factors that significantly increase the risk of cardiovascular disease, such as a sedentary lifestyle, elevated cholesterol, smoking, high blood pressure, and higher than ideal body weight."

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Pregnant and Postpartum Women

Medicaid shall cover dietary evaluation and counseling for pregnant women when the pregnancy is threatened by chronic, episodic, or acute conditions for which nutrition therapy is a critical component of medical management, and for postpartum women who need follow-up for these conditions or who develop such conditions early in the postpartum period, including any one of the following:

• a. Conditions that affect the length of gestation or the birth weight, where nutrition is an underlying cause, such as:

  • 1. Severe anemia [Hemoglobin (HgB) less than 10m/dl or Hematocrit (Hct) less than 30].

  • 2. Preconceptionally underweight (less than 90% standard weight for height).

  • 3. Inadequate weight gain during pregnancy.

  • 4. Intrauterine growth retardation.

  • 5. Very young maternal age (under the age of 16).

  • 6. Multiple gestation; or

  • 7. Substance use.

• b. Metabolic disorders, such as diabetes, thyroid dysfunction, maternal PKU, or other inborn errors of metabolism.

• c. Chronic medical conditions, such as cancer, heart disease, hypertension, hyperlipidemia, inflammatory bowel disease, malabsorption syndromes, or renal disease.

• d. Auto-immune diseases of nutritional significance, such as systemic lupus erythematosus.

• e. Eating disorders, such as severe pica, anorexia nervosa, or bulimia nervosa

• f. Obesity when the following criteria are met:

  • 1. Body Mass Index (BMI) greater than 30 in same woman pre-pregnancy and postpartum.

  • 2. BMI greater than 35 at 6 weeks of pregnancy; or

  • 3. BMI greater than 30 at 12 weeks of pregnancy. or

• g. Documented history of a relative of the first degree with cardiovascular disease or possessing factors that significantly increase the risk of cardiovascular disease, such as a sedentary lifestyle, elevated cholesterol, smoking, high blood pressure, and higher than ideal body weight.

 

Note: If eligible, NCHC beneficiaries, ages 6 through 18 years of age, who become pregnant and have been transferred to another appropriate Medicaid eligibility category that includes pregnancy coverage are eligible for this service.