Excellent question! At this point, the research shows that if the capsule looks nice and thin and normal, there is no reason to have to remove it. There is some thought that there could be a "biofilm" which means some bacteria, but no real evidence that this makes any long term difference as far as complications. Leaving healthy capsule tends to be the safer procedure.
A BBL is a great option for you! It will really help your shape and improve your proportions. Liposuction alone would help the love handles, but filling out the buttocks with the fat taken from liposuction will give you a more feminine shape. You do not have to transfer a huge volume to the buttocks. If you want a more natural look, a smaller amount can be transferred.
They most likely will! There are two ways it could be covered. First, if your hidradenitis is on the bottom part of your breast, this is the tissue that is usually removed in a breast lift or breast reduction anyways. Medicaid will definitely cover the excision of hidradenitis tissue, so if that is your diseased area it will be covered. The other way is to have it covered as a small breast reduction, which uses the same incisions as a breast lift. One of the covered reasons for a reduction is rash or infection that persists despite medical treatment. Because you will not need much volume removed, it may take a bit of back and forth with the insurance company, but you will most likely be able to get it covered one way or the other. Medicaid usually requires prior authorization before you can get a procedure, so your doctor should submit your case and let you know for sure whether it is approved or not beforehand.