Authors: Megan Terrell, Center for Health Care Strategies

An estimated 40 million Americans have type 2 diabetes, and another 110 million live with prediabetes. These conditions disproportionately affect people enrolled in Medicaid and lead to annual health care costs that are thousands of dollars higher than for those without diabetes. The National Diabetes Prevention Program (National DPP), developed by the Centers for Disease Control and Prevention (CDC), is an evidence-based lifestyle change program for individuals with prediabetes. The program reduces the risk of developing type 2 diabetes and supports additional health improvements, including weight loss, increased physical activity, healthy eating, and stress management.

The National DPP builds upon findings from the Diabetes Prevention Program Research Group demonstrating the impact of lifestyle change programs in reducing the incidence of type 2 diabetes. Over the past decade, the program has expanded nationwide through investments from CDC and the Centers for Medicare & Medicaid Services (CMS), along with partnerships across national organizations, states, and local communities. As Medicaid programs continue to seek effective strategies to prevent chronic disease, improve population health, and manage rising costs, the National DPP offers a scalable, evidence‑based opportunity to support beneficiaries at high risk for diabetes.

How does the National DPP work?

Individuals who meet age, weight, diagnostic, and risk criteria can enroll in a CDC-recognized National DPP, which may take place virtually or in-person, such as at a health care clinic or a community-based organization. More than 2,300 recognized programs meet CDC standards for eligibility, curriculum, staffing, data reporting, and other requirements. Once enrolled, participants engage in the program for one year with two phases: a six-month learning phase and a six-month maintenance phase. During the learning phase, participants attend sessions led by a trained Lifestyle Coach, who helps them set goals and build skills related to physical activity, healthy eating, stress management, reducing diabetes risk, and related topics. The maintenance phase involves monthly meetings with the coach to sustain these behaviors. Programs report participant data, including session attendance, weight, and physical activity, to the CDC every six months. Program Coordinators support Lifestyle Coaches by managing session logistics, scheduling, and data collection and reporting to maintain CDC recognition.

What is the policy and funding landscape surrounding the National DPP and Medicaid coverage?

Following the creation of the National DPP, CDC and CMS established infrastructure and funding mechanisms to increase program enrollment, especially in higher-risk, underserved communities. Examples of these investments include the Medicaid Incentives for Prevention of Chronic Disease Model and the Improving the Health of Americans Through Prevention and Management of Diabetes, Heart Disease, and Stroke cooperative agreement. These initiatives encouraged states to pursue Medicaid coverage for the National DPP and to develop strategies that incentivize beneficiary participation. The National DPP is also available to eligible Medicare beneficiaries through the Medicare Diabetes Prevention Program, covered under Part B as a preventive service.

Many states have opted to cover the National DPP through Medicaid, with early adopters including Montana and Minnesota. In 2016, the National Association of Chronic Disease Directors (NACDD) launched a demonstration project to support Maryland and Oregon in implementing the program through managed and accountable care organizations. Today, more than 30 states provide Medicaid coverage for the National DPP using mechanisms such as Section 1115 waivers, state plan amendments, and managed care pilots. As states expand coverage, key implementation priorities include provider and health plan onboarding and billing, as well as participant recruitment and retention. NACDD supports states through technical assistance, tools, and training, with resources available in the National Diabetes Prevention Program Coverage Toolkit.

What is the evidence on the National DPP?

Evidence for the National DPP and early diabetes prevention interventions consistently shows that structured lifestyle change programs are effective in promoting weight loss, increasing physical activity and healthy eating, and reducing diabetes risk diagnoses.

What resources are available to support Medicaid coverage and implementation of the National DPP?

As opportunities to support diabetes prevention programs expand, stakeholders can draw on a growing set of case examples and tools that illustrate how states and partners are implementing the National DPP through Medicaid. Key resources include:

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