Bailey v. Mont. Dep’t of Pub. Health & Human Servs.

Lisa Bailey, a fifty-one-year old who was considered morbidly obese, requested, through her physician, Medicaid authorization for gastric bypass surgery. The Montana Department of Public Health and Human Services (Department) denied the request because gastric bypass surgery is a non-covered service under Department administrative rules. A hearing officer upheld the Department’s determination, and the Board of Public Assistance adopted the decision of the hearing officer. The district court affirmed. Bailey appealed, asking that the Department be required to conduct a determination of medical necessity for the procedure. The Supreme Court affirmed, holding that the Department’s rule excluding coverage for all invasive procedures undertaken for the purpose of weight reduction, including gastric bypass surgery, is not unreasonable or contrary to federal law. View "Bailey v. Mont. Dep’t of Pub. Health & Human Servs." on Justia Law