Learning from the experiences of other states can provide unique insights into the opportunities and challenges states may face when increasing Medicaid continuous glucose monitor (CGM) access. The resources in this section can help states looking to learn from other states’ experiences in improving CGM access.
Expanding Access to Continuous Glucose Monitors in Kentucky Through Cross-Agency Partnerships
This profile highlights how Kentucky — through a data-driven, collaborative approach — updated its Medicaid CGM policy and targeted outreach and resources to members and providers to increase the use of CGMs and other diabetes-related supports.
Medicaid Opportunities to Improve Gestational Diabetes Outcomes Through Expanded Access to Continuous Glucose Monitors
This blog post explores how states are expanding access to continuous glucose monitors for pregnant people.
Transforming Diabetes Care with Data: Oklahoma Medicaid’s Continuous Glucose Monitor Policy
This blog highlights how Oklahoma Medicaid is using claims data to shape continuous glucose monitor (CGM) policy and expand access for members with diabetes. The analysis tracks outcomes such as inpatient visits, insulin use, and overall cost to assess return on investment. These insights have informed streamlined prior authorization, care management outreach, and future efforts to extend CGM coverage to high-risk populations.
Improving Access to Continuous Glucose Monitors for Texans Through Medicaid
This state profile walks through Texas Medicaid’s efforts to expand access to continuous glucose monitors (CGMs) by revising coverage criteria, streamlining prior authorization, and prioritizing provider education to support early CGM adoption for individuals with diabetes, including those with gestational diabetes.
Improving Diabetes Care Through Access to Continuous Glucose Monitors in Medicaid: State Opportunities
This blog post highlights key takeaways from a multi-state convening focused on expanding CGM access in Medicaid, summarizing state strategies to improve coverage, address provider and patient education, and advance health outcomes through early adoption and targeted outreach.
Best Practices and Rationale for Expanding Medicaid Access to Continuous Glucose Monitoring
Documents a primary care CGM integration pilot program at MetroHealth System in Cleveland, Ohio, and highlights best practices for expanding CGM coverage for Medicaid beneficiaries.
Vermont: Pharmacy Benefit Considerations for Continuous Glucose Monitoring Acquisition — Vermont Medicaid Experience
Outlines Vermont Medicaid’s experience transitioning CGM coverage from a medical/durable medical equipment benefit to a pharmacy benefit.
Wisconsin: Personal Continuous Glucose Monitoring Survey
Documents survey findings by the Wisconsin Diabetes Advisory Group including: (1) approaches by clinics and health systems to facilitating access to personal CGM; (2) barriers for clinicians in prescribing CGM; and (3) opportunities for advancements against noted barriers.
Ohio: Diabetes Quality Improvement Project Toolkit
Presents strategies that health care providers can use to improve health outcomes and reduce HbA1c levels among patients enrolled in Medicaid with type 2 diabetes.
Washington State: Glucose Monitoring
Documents the Washington State Health Care Authority’s 2011 and 2018 review of CGM to inform their coverage determination.
Oregon: Evidenced-Based Report Blog — Continuous Glucose Monitoring in Diabetes Mellitus
Reviews clinical evidence and provides guidance on medical procedures, devices and tests paid for by the Oregon Health Authority. Includes resources on Oregon Health Evidence Review Commission coverage recommendations for Medicaid CGM coverage of people with type 1, type 2, and gestational diabetes of varying insulin-dependence.
