Missouri's New Eating Disorder Law

Missouri State Building
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On June 19, Missouri became the first state in the US to require health insurance companies to provide proper diagnosis and treatment for eating disorders. Governor Nixon signed Senate Bill 145, which goes into effect on January 21, 2017.

Missouri, like many states, has had a mental-health parity law requiring insurance companies to provide equal benefits for treatment of mental illness and physical ailments, including eating disorders.

Despite this, companies continue to find loopholes to circumvent this coverage. The legislation in Missouri is designed to close some of these loopholes.

The law provides insurers clear guidelines to use when considering whether an eating disorder treatment should be covered. The law stipulates that:

Medical necessity determinations and care management for the treatment of eating disorders shall consider the overall medical and mental health needs of the individual with an eating disorder, shall not be based solely on weight, and shall take into consideration the most recent Practice Guideline for the Treatment of Patients with Eating Disorders adopted by the American Psychiatric Association…

Insurance companies will no longer be allowed to make decisions based solely on weight or other single data points which don’t take into account the full picture including the individual’s psychological state.

  Further, they will be required to consider best practices as determined by the psychiatry community in making these decisions.

The sponsor of the bill, Missouri State Sen. David Pearce (R), said that, contrary to insurance companies’ concerns about cost burden of the new law, he expects the legislative changes to ultimately lower costs by ensuring that insurance companies proactively act to prevent future hospitalization or death.

Eating disorder advocate Annie Seal spearheaded SB 145, a bill 7 years in the making. Annie’s daughter recovered from an eating disorder and she had battled insurance to obtain coverage for her daughter’s treatment. Annie worked with the National Eating Disorder Association (NEDA)’s Solutions through Advocacy and Reform (STAR) program, the Missouri Eating Disorders Association (MOEDA), and numerous other advocates and sponsors to push through this landmark legislation.

The eating disorder community is excited about this law and hopes it will pave the way for similar legislation in other states. Families and patients throughout the United States struggle to obtain adequate treatment for eating disorders. Because of their complexity (spanning both medical and mental health issues) and their potential severity, eating disorders often require a coordinated multidisciplinary treatment. Treatment may be expensive and many clients without insurance are unable to access treatment. Many clients with insurance coverage face premature termination of treatment when insurance cuts off reimbursement in an attempt to contain costs.

This contributes to relapses and longer durations of illness, which ironically often increase costs as more treatments and services are needed over the long term. Many families and sufferers also incur debt paying out of pocket for treatment services. In addition to the direct costs of health care for eating disorder treatment, the loss of earnings related to suffering from an eating disorder is greater in magnitude than the excess health care costs associated with the disease.

According to NEDA, in the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder.  Eating disorders have the highest mortality rate of any psychiatric illness. Short of death, eating disorders are associated with numerous medical consequences. Early treatment improves the prognosis for a full recovery

To learn more about getting involved in eating disorder legislative reform in the United States, check out NEDA’s STAR program and the Eating Disorders Coalition for Research, Policy, and Action.


Samnaliev, M, Noh, HL, Sonneville, K, Austin, SB.  (2014).  The economic burden of eating disorders and related mental health comorbidities: An exploratory analysis using the U.S. Medical Expenditures Panel Survey.  Science Direct, 2:  32-34.

Missouri Senate Bill 145

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