Understanding the impact of continuous glucose monitor (CGM) expansion on Medicaid policy and health care coverage is important when developing CGM action plans and strategies. The resources in this section can assist states looking to understand how and which coverage policies play a role in supporting widespread adoption of CGM technology.
Implementing Continuous Glucose Monitors as a Pharmacy Benefit: A Policy Checklist for States
Offers implementation guidance to states interested in transitioning their CGM coverage from a durable medical equipment to a pharmacy benefit. The checklist can also support states newly implementing CGM coverage and considering doing so as a pharmacy benefit.
Continuous Glucose Monitor Access for Medicaid Beneficiaries Living with Diabetes: State-By-State Coverage
Builds on a 2022 CHCS report, Expanding Medicaid Access to Continuous Glucose Monitors, and includes an update on state-by-state CGM coverage in Medicaid, including steps taken by states to reduce barriers to CGM access.
Payer Best Practices in Prior Authorization: Minimizing Barriers to CGM Access
Outlines approaches to reducing CGM access barriers through minimizing challenges associated with prior authorization.
Expansion of Medicaid Coverage of Continuous Glucose Monitor Reduces Health Disparity
Highlights the positive impact of California’s 2022 expansion of Medicaid CGM coverage to all Medicaid enrollees with type 1 diabetes without requiring a minimum number of glucose tests per day.
Effect of CGM Access Expansion on Uptake Among Patients on Medicaid
Investigates the positive impact of providing complete subsidies, irrespective of diabetes type, on CGM adoption rates and HbA1c outcomes in Medicaid populations.
Increase Access, Reduce Disparities: Recommendations for Modifying Medicaid CGM Coverage Eligibility Criteria
Presents a justification for adjustment and uniformization of Medicaid CGM coverage eligibility.
Delays in Continuous Glucose Monitoring Device Initiation: A Single Center Experience and a Call to Change
Investigates one call center’s process of prescribing CGM to patients and notes the different factors and barriers associated with successful initiation of CGM acquisition and use, including patient age, insurance status, and education with a clinical diabetes educator.
Expanding Medicaid Access to Continuous Glucose Monitors
Details the importance of CGM access expansion, the current Medicaid coverage landscape, state Medicaid approaches to covering CGM, and recommendations to improve CGM access in Medicaid.
Relationships Between Socioeconomic Status, Insurance Coverage for Diabetes Technology and Adverse Health in Patients With Type 1 Diabetes
Describes CGM access disparities due to socioeconomic status and insurance coverage and the resulting downstream impacts on health outcomes, including disparities in rates of diabetic ketoacidosis and hypoglycemia.
Pediatric Medicaid Patients With Type 1 Diabetes Benefit From Continuous Glucose Monitor Technology
Studies the uptake rate of CGM and analyzes clinical and demographic associations of pediatric CGM usage for individuals with type 1 diabetes covered by the 2015 implementation of a CGM Medicaid benefit in Colorado.
Durable Medical Equipment Fee-for-Service Payment Policy
Outlines Medicaid durable medical equipment fee-for-service payment policies, equipment and supply coverage standards, utilization management policies, and competitive bidding and manufacturer rebate programs.
CGM Insurance Coverage Tool
Helps consumers determine CGM insurance coverage based on payer, plan type, and state.
