Gestational diabetes (GDM) — marked by high blood sugar levels during pregnancy in individuals without a prior history of diabetes — affects approximately nine percent of pregnancies in the United States annually. Untreated, GDM can lead to pregnancy complications, such as above average birth weight, breathing problems for the baby, higher risk of pre-eclampsia, and premature birth.
Medicaid, which covers nearly half of all births across the country, can play a critical role in improving outcomes for pregnant people with GDM by expanding access to continuous glucose monitors (CGMs). CGMs have been shown to significantly enhance self-management of GDM, contributing to better maternal and infant health outcomes. While most states cover CGMs for other forms of diabetes, two-thirds currently provide Medicaid CGM coverage to individuals with GDM — and many impose stringent limitations on this coverage.
CGMs are considered the standard of care for people with diabetes. These devices have been proven to: (1) improve glycemic control and health outcomes; (2) provide greater freedom in managing blood sugar; and (3) achieve cost savings for states and other payers. For individuals with GDM, studies show that CGMs support positive neonatal outcomes by improving detection of high and low blood sugars. However, access to CGMs for people with GDM can be challenging. Long delays in obtaining CGMs can mean individuals do not receive them until late in pregnancy — or even after delivery — missing the opportunity to potentially reduce further complications. Barriers, such as a requirement for insulin dependence, prior authorizations, and individual states’ strict Medicaid CGM coverage eligibility can impact a person’s ability to obtain a CGM.
This blog post explores how states are expanding access to CGMs for pregnant people. It is a product of the CGM Access Accelerator, a national initiative supporting seven states — Iowa, Kentucky, Michigan, New Jersey, Oklahoma, South Dakota, and Texas —that are transforming their approach to addressing diabetes in Medicaid populations through increased access to CGMs. The initiative is led by the Center for Health Care Strategies with support from The Leona M. and Harry B. Helmsley Charitable Trust.
Preventing GDM from Advancing to Type 2 Diabetes
Between 20 and 50 percent of people with GDM develop type 2 diabetes postpartum. And, overall, the risk is highest within the first three to six years following pregnancy. The risk of advancing from GDM to type 2 diabetes is impacted by how well-controlled blood glucose levels are during pregnancy, as well as other factors, such as timing of GDM diagnosis, history of GDM in previous pregnancies, and the level of pregnancy-induced glucose intolerance. Studies show that CGM devices are beneficial for people with GDM in both the pregnancy and postpartum periods, and these benefits may reduce the risk of developing type 2 diabetes post-partum.
State Opportunities to Increase CGM Access for People with GDM
To expand access to CGMs for people with GDM, states can consider removing insulin requirements, prior authorization, and other barriers to access. Following are examples from states participating in CHCS’ CGM Access Accelerator that not only cover CGM access for people with GDM but also have revised their coverage to reduce access barriers.
| STATE | CGM COVERAGE FOR PEOPLE WITH GESTATIONAL DIABETES |
| Iowa | Member has a diagnosis of GDM or any type of diabetes in pregnancy and meets the following: – The member (or a caretaker) has demonstrated the ability to use a CGM and make adjustments; and – Treatment guidelines have been provided to the member (or a caretaker) that allow them to safely and effectively take advantage of the information provided by the device. |
| Kentucky | Member has a diagnosis of GDM (ICD-10 group 024). |
| Michigan | Members with “diabetes in pregnancy, childbirth, and the puerperium period (insulin or non-insulin treated)” do not require prior authorization to access a CGM. |
| South Dakota | Medicaid covers the purchase of a CGM, including sensors, with a prior authorization for a member who has GDM. |
| Texas | Member has diabetes and meets the following criteria: – Is insulin-treated; or – Has a history of problematic hypoglycemia with documentation of at least one of the following: – Recurrent level 2 hypoglycemic events (glucose <54 mg/dL [3.0 mmol/L] that persist despite multiple attempts to adjust medication(s) and/or modify the diabetes treatment plan; or – A history of one level 3 hypoglycemic event (glucose <54 mg/dL [3.0 mmol/L]) characterized by altered mental and/or physical state requiring assistance for treatment of hypoglycemia. – A member with hypoglycemia unawareness or several episodes of hypoglycemia a day also qualifies for the CGM benefit if the client does not meet the criteria outlined above. |
State Perspective: Expanding CGM Access for the GDM Population in Kentucky
As part of its work in the CGM Access Accelerator, Kentucky updated its CGM policy by removing the requirement of insulin dependence with GDM to qualify for a CGM. Kentucky made this change after an analysis of CGM utilization data revealed low use among members with GDM. Further, the analysis showed that a significant number of members went on to have a type 2 diabetes diagnosis following pregnancy. After the policy change was made, CGM utilization among members with GDM increased significantly — from seven to 67 members over six months. The state will continue to track and monitor this information with a five-year “look back” analysis to review how many members with GDM developed type 2 diabetes. They also plan to continue collecting data on CGM utilization, including specifically for members with GDM.
Looking Ahead
Expanding Medicaid coverage of CGMs for people with GDM can improve maternal and infant health outcomes during pregnancy and reduce the long-term risk of type 2 diabetes. By removing unnecessary restrictions, such as insulin requirements and prior authorizations, states can ensure timely access to these proven devices. Expanding CGM access for pregnant people represents a practical, evidence-based step toward healthier pregnancies and healthier futures for families.
