States have made significant progress in expanding Medicaid coverage for diabetes technology, including continuous glucose monitors (CGMs). These tools are the standard of care — helping people with diabetes better manage their blood sugar, which can lead to better health outcomes, reduced complications, and improved quality of life. As of 2023, 45 states and the District of Columbia offer some level of coverage through Medicaid fee-for-service programs — a substantial expansion of coverage in just a few years.

But coverage alone does not guarantee access. As more states expand coverage, a new challenge has emerged: many Medicaid members still face barriers to obtaining and using these life-changing technologies. While coverage is a critical foundation, other factors influence access and utilization — beyond a state’s coverage policy — including administrative complexity, provider readiness, and user experience. Through CHCS’ recent CGM Access Accelerator, states identified a range of challenges that influence whether coverage translates into uptake and improved outcomes. Their experiences point to three areas for continued Medicaid innovation:

1. Administrative complexity. Prior authorization requirements, documentation burdens, benefit design decisions, and restrictions on eligible providers can make devices difficult to obtain. States can reduce these barriers by streamlining prior authorization processes, minimizing unnecessary paperwork and renewal requirements, expanding the range of clinicians who can prescribe diabetes technology, and simplifying how members obtain devices and supplies. For example, states are increasingly exploring coverage of CGMs through the pharmacy benefit, either in addition to, or instead of as durable medical equipment, to simplify access and reduce barriers to obtaining devices and supplies.
2. Provider readiness. Diabetes technologies generate valuable information, but clinicians need greater support to prescribe devices, interpret data, and involve patients in treatment decisions. These challenges can be especially pronounced in primary care settings and communities with fewer endocrinologists. States can invest in quality incentives, provider education, care team capacity, and workflows that make it easier for clinicians to incorporate and prioritize diabetes technology into routine care.
3. User experience.  Receiving a device does not ensure that someone can use it successfully over time. Many diabetes technologies rely on smartphones, internet connectivity, and patient engagement. People may need help setting up devices, understanding data displays, troubleshooting technical issues, or incorporating the technology into daily routines. Language access, digital and health literacy, and other social and economic factors can also influence whether a covered device translates into improved health outcomes. States can partner with community organizations to better understand and address member access barriers. Michigan, for example, partnered with a civic organization in Detroit to hear directly from community members about their CGM experiences. Participants reported limited awareness of CGM benefits, few provider recommendations, and concerns about stigma within their communities. These insights helped the state develop more community-informed strategies to support CGM adoption and continued use.

Helping States Close the Gap Between Coverage and Use

Medicaid programs are making important progress expanding access to CGMs, but there is room to maximize reach and impact for members who would benefit most. At the same time, states are increasingly exploring opportunities to improve access to automated insulin delivery (AID) devices —systems that pair CGMs with insulin pumps to automatically adjust insulin delivery — which can further transform diabetes care for those requiring insulin. The lessons learned from expanding CGM access will be critical as states consider broader access to AID devices.

As states confront rising rates of diabetes and persistent challenges accessing specialty care, particularly in rural and underserved communities, diabetes technologies offer an important tool for improving chronic disease management and promoting patient-centered care. To help states advance this work, CHCS is currently accepting applications for the CGM & AID Devices Access Accelerator. This 18-month technical assistance and peer learning opportunity, made possible through support from The Leona M. and Harry B. Helmsley Charitable Trust, will help Medicaid programs expand access to diabetes technology, including CGMs and AID devices, and provide participating states with up to $75,000 to advance implementation priorities. Participation in the Accelerator offers states an opportunity to advance broader Medicaid and health system priorities, including strengthening chronic disease prevention and management efforts; complementing rural health transformation efforts; and exploring approaches to promote continuity of Medicaid coverage and sustained access to diabetes technology. Medicaid agencies interested in participating are encouraged to learn more and apply.