In the U.S., diabetes prevalence has increased over the past two decades and is the seventh leading cause of death. Moreover, one of every four dollars spent on health care go toward caring for individuals with diabetes. The condition disproportionately impacts people with lower incomes, including those covered by Medicaid, and their care needs are often not met. Compared to people with commercial insurance, Medicaid beneficiaries experience higher rates of poor diabetes management, worse glycemic control, and experience more barriers to care, as well as more acute- and long-term complications related to diabetes. These disparities point to a critical role for Medicaid agencies in improving access to quality care to both improve outcomes and reduce costs for this population.

Improving Diabetes Care in Medicaid Through Continuous Glucose Monitoring

Expanding access to continuous glucose monitors (CGM) — particularly for Black, Indigenous, and people of color who are more likely to be diagnosed with diabetes than white individuals — is a key way for states to improve diabetes care and reduce health inequities for high-risk populations. CGM use is the standard of care for insulin-treated people with diabetes. Studies show that more widespread use of and access to CGMs can improve clinical quality and health outcomes, reduce health care costs, and support health equity efforts.

As of May 2023, 45 states and the District of Columbia have some level of CGM fee-for-service coverage. While there is no consistent CGM policy across all states, there are common components adopted by Medicaid agencies that cover CGMs. Yet, even when CGMs are covered, guidelines and restrictions can potentially create unintended consequences that may worsen disparities in health outcomes for people with diabetes.

Although states and other stakeholders in the diabetes field increasingly recognize the importance of reducing disparities for Medicaid beneficiaries with insulin-requiring diabetes, particularly by increasing access to CGMs, there is no dedicated national network or technical assistance program to guide this work.

Supporting States to Expand Access to CGMs in Medicaid

With support from The Leona M. and Harry B. Helmsley Charitable Trust, the Center for Health Care Strategies (CHCS) launched Accelerating Access to CGMs in Medicaid to Improve Diabetes Care, an initiative to support states in designing and implementing strategies to increase the number of Medicaid beneficiaries who can obtain and use a CGM to improve their health and well-being. Opportunities and resources available to states through the initiative include:

• An 18-month CGM Access Accelerator technical support and peer learning opportunity for Medicaid agencies and their partners. The Accelerator is designed to help states transform their approach to addressing diabetes and move the needle on reducing health inequities in Medicaid by increasing access to CGMs. Selected states will have access to comprehensive supports, and technical assistance designed to help states accomplish these goals, including the ability to direct up to $75,000 in Accelerator funds to support CGM efforts. (State teams will be announced in Fall 2023);
• A short-term CGM Policy Navigator, available to all states separate from the CGM Access Accelerator program, that offers ad-hoc and less intensive targeted technical support to increase access to CGMs in Medicaid. (For more information, please contact CGMAccess@chcs.org); and
• A public online resource center (launching later in 2023) to broadly support stakeholders across the U.S. seeking to expand access to CGMs for Medicaid beneficiaries.