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.
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.
