The Nutrition CARE Act and the Eating Disorder Coverage Gap Medicare Still Has Not Closed
- H.R.2495, the Nutrition CARE Act of 2025, would extend Medicare coverage of Medical Nutrition Therapy (MNT) to beneficiaries with eating disorders — currently MNT is covered only for diabetes and renal disease.
- Medicare explicitly does not cover MNT at the outpatient level for eating disorders, and provides no coverage at intensive outpatient or residential levels — the three tiers where most eating disorder care actually happens.
- Parity enforcement by DOL/HHS has made medical necessity criteria for eating disorder residential treatment that are more restrictive than medical-inpatient criteria an explicit MHPAEA violation — but the gap between rule and implementation remains wide.
- Appeals data shows a 61% overturn rate when eating disorder denials are properly documented and challenged — a number that simultaneously indicts the denial rate and argues that clinician-assisted appeals are high-leverage work.
Eating disorder care in the U.S. still sits at the worst possible intersection: high clinical acuity, long treatment arcs, and a reimbursement architecture designed for episodic medical-surgical encounters. The Nutrition CARE Act is a narrow but consequential fix — and the fact that Congress is still debating a coverage expansion that should have been obvious a decade ago tells you where the baseline is.
The policy state in 2026
The 21st Century Cures Act (2016) placed eating disorders explicitly under MHPAEA parity requirements. The 2024 MHPAEA Final Rule, now in full effect, requires plans to document Non-Quantitative Treatment Limitations (NQTL) and demonstrate that mental health coverage is not applied more restrictively than medical-surgical equivalents. On paper, this should solve the residential-treatment denial problem for eating disorders.
On the ground it does not. Plans continue to deny residential and intensive outpatient care using internally constructed medical necessity criteria that look clinical but function as cost-control mechanisms. Project HEAL and peer organizations report that the appeals process routinely overturns these denials at 61%-plus rates — which means the majority of initial denials are wrong by the plan's own documented standards.
The Nutrition CARE Act addresses one specific hole: Medicare recipients with eating disorders cannot access reimbursed MNT, which is a core component of evidence-based treatment (FBT, CBT-E, and MANTRA all integrate dietitian support). The bill has been referred to Energy & Commerce and Ways & Means; passage prospects in 2026 are uncertain given the broader Congressional calendar.
For your practice
Three concrete implications. First: if you treat eating disorders, appeals work is part of the clinical job in 2026. A well-documented appeal, citing specific MHPAEA NQTL language and the evidence base for the requested level of care, wins the majority of the time. That is both a condemnation of the denial pattern and an opportunity — clinicians who write good appeals letters effectively multiply their clinical impact.
Second: the Medicare MNT gap matters most for older adults with late-onset or relapsing eating disorders, a population that is underserved, underdiagnosed, and growing as the first wave of diagnosed ED patients ages into Medicare eligibility. If you see this population, know which services are reimbursed and which are not; consider sliding-scale or pro-bono dietitian referrals as a bridge.
Third: document medical necessity language that pre-empts NQTL objections. Courts and regulators are reading these files. "Patient requires daily caloric rehabilitation under monitored conditions per [guideline]" carries weight that "patient would benefit from residential care" does not.
When 61% of eating disorder denials are overturned on appeal, the denial rate is not a clinical judgment — it is a cost-control strategy with a financial expectation of provider exhaustion.
Policy state evolves monthly; the Nutrition CARE Act may advance, stall, or be consolidated into a larger package. Appeals overturn rates come from advocacy organizations and may not represent universal insurer practice.