Diabetes affects millions of people across the country, with Medicaid beneficiaries experiencing disproportionately high rates due to inconsistent access to care. Advancements in blood sugar management technology, like continuous glucose monitors (CGMs), offer opportunities to transform diabetes management by providing real-time glucose monitoring. Having this information supports healthier decision making and reduces complications for people living with diabetes. Yet, despite the proven benefit of these devices, disparities in access to CGMs persist in Medicaid.

Improving access to CGMs is a critical strategy to support the health and well-being of people with diabetes. Through the CGM Access Accelerator, led by the Center for Health Care Strategies with support from The Leona M. and Harry B. Helmsley Charitable Trust, seven states — Iowa, Kentucky, Michigan, New Jersey, Oklahoma, South Dakota, and Texas — worked to strengthen access to CGMs and transform diabetes care for Medicaid members. Drawing on insights from the initiative, this blog post outlines practical opportunities for other states looking to improve the health of people living with diabetes.

Key Opportunities for Expanding CGM Access

The following are practical state strategies for expanding access to CGMs for Medicaid members informed by lessons from the CGM Access Accelerator.

• Align clinical criteria with national standards to improve clarity and expand access. Updating state Medicaid coverage policy to align with Medicare policy guidelines and the American Diabetes Association’s Standards of Care in Diabetes increases provider clarity on CGM eligibility while simultaneously expanding CGM access to patients not using insulin. In Texas, this meant expanding CGM eligibility to include insulin-treated type 2 diabetes and members with frequent problematic hypoglycemia as well as an added provision to cover current and future FDA-indicated CGMs.
• Standardize managed care criteria to reduce variation in coverage across members. Inconsistent CGM policies across health plans can create confusion for prescribers and limit access to CGMs. By aligning CGM criteria across managed care organizations (MCOs), states can support more streamlined member access. In New Jersey, the state is working toward standardizing eligibility across all MCOs.
• Broaden eligibility to close coverage gaps for gestational diabetes and/or high-risk type 2 diabetes. Medicaid policies often limit CGM coverage to members with type 1 diabetes, leaving persistent access gaps for members with gestational diabetes and members with type 2 diabetes. Expanding clinical criteria for accessing CGMs — beyond insulin-treated people with type 1 diabetes — can support healthier pregnancies and better diabetes management. Kentucky Medicaid updated its coverage for CGMs to include members with gestational diabetes regardless of insulin use and for adults with type 2 diabetes with problematic hypoglycemia. For patients with gestational diabetes, this policy change led to a rapid increase in CGM prescriptions — from six to 67 in just six months. To support additional uptake, Kentucky launched targeted email campaigns and created centralized provider and member resource pages with introductory CGM information, coverage details, and referral tools. South Dakota also expanded CGM coverage to beneficiaries with gestational diabetes and beneficiaries with type 2 diabetes using rapid acting insulin.
• Establish both pharmacy and durable medical equipment (DME) benefit pathways to increase flexibility for providers and members. Offering access through both channels gives providers greater prescribing flexibility and enables members to obtain devices in the way that best meets their needs. Evidence suggests that adding a pharmacy benefit can increase CGM uptake, while maintaining DME channels may support treatment adherence — particularly in resource-limited areas, such as rural communities. Iowa is in the process of broadening its Medicaid CGM prescribing policy to include both pharmacy and DME pathways, replacing its current DME-only policy. This update will ultimately support greater flexibility and more timely access for Iowa Medicaid members.
• Leverage Medicaid data to identify high-need populations and inform CGM policy decisions. Analyzing claims data can help identify high-risk groups — such as people with pre-existing conditions — who might benefit from CGM intervention. In Oklahoma, data showed health declines before CGM initiation followed by improvements after CGM implementation. These findings led the state Medicaid agency to streamline prior authorization for members with recent insulin use. The data also informed updated provider education and expanded access for high-risk groups.
• Engage community and provider partners to understand barriers and tailor solutions. Direct input from Medicaid members and frontline partners on state policies and program design can uncover obstacles in accessing and using CGMs — and inform targeted solutions. In Michigan, the Department of Health & Human Services partnered with the Detroit Association of Black Organizations to convene focus groups that identified barriers to CGM use in Black communities. Participants cited limited awareness about the devices, stigma, and difficulties navigating coverage. The state also worked with Cherry Health, a federally qualified health center, to launch a CGM pilot program that helped more than 500 patients access CGMs. Insights from the pilot are now informing provider outreach, member education, and process simplifications.
• Support provider education on CGMs to expand prescribing confidence. CGMs are typically prescribed by endocrinologists, yet there is a nationwide shortage of endocrinologists — especially in rural areas and for Medicaid members. Educating primary care and OB/GYN providers on CGM technology, billing, and treatment integration can expand prescribing capacity. South Dakota’s Medicaid agency held a statewide training to help OB/GYNs and other clinicians prescribe, initiate, and sustain CGM use in pregnancy care.

Next Steps

The CGM Access Accelerator provided states with a forum to identify policy opportunities and share strategies to address barriers to CGM access among Medicaid members. These lessons serve as a foundation for continued progress in expanding access to CGMs — and other emerging technologies, such as automated insulin delivery systems — and their use nationwide. Other states can apply these strategies to ensure that all people with diabetes have access to the tools needed to manage their health effectively.