Preventive Health Assistance (PHA) is a program that provides two additional benefits for Medicaid participants, the Weight Management Benefit and the Children’s Wellness Benefit.
Weight Management Benefit
The Weight Management Benefit (WM) provides opportunities designed to help eligible participants and their families improve their lifestyle through:
- Physical Fitness
- Balanced Diet
- Personal Health Education
Qualifying participants can earn up to $200 each year to help pay for services offered by PHA providers such as participation in the National Diabetes Prevention Program, fees for a weight management program, gym membership, healthy lifestyle classes, or nutrition classes or services. Any additional fees are the participant’s responsibility.
Participants must have full Basic or Enhanced Medicaid coverage to qualify. Participants on the Home Care for Certain Disabled Children Program (Katie Beckett) and Medicare-Medicaid Coordinated Plan participants are not eligible for these benefits. Participants must also meet the following criteria by age:
- Adults (21 and older): a body mass index (BMI) of 30 or higher or 18.5 or lower according to the CDC Adult BMI Calculator.
- Children (5 to 21 years old): a body mass index (BMI) that falls in either the overweight or the underweight category according to the CDC Child and Teen BMI Calculator.
Participants interested in the program should visit their Primary Care Provider (PCP). The PCP will initiate the process by printing and filling out their portion of the WM Agreement Form. The participant is then responsible for filling out their section of the form. Then the participant takes the form to the WM provider they’ve chosen to receive services from for their signature. Once all sections are complete the form must be submitted to the PHA program for approval. The benefit will start on the date of approval.
Don't forget to complete all sections of the form before submitting it for approval or the form will be returned as incomplete and the process will be delayed.