Diabetes is the eighth leading cause of death in the U.S., and individuals living with diabetes face serious disease-related complications — such as kidney disease, lower limb amputations, and heart and vascular issues. Moreover, diabetes disproportionately impacts Medicaid beneficiaries when compared to the general public, with Medicaid beneficiaries experiencing higher rates of poor diabetes management, worse glycemic outcomes, more barriers to care, and more condition-related complications.
Continuous glucose monitors (CGMs) are the standard of care for people with type 1 diabetes, and a recommended tool for people with type 2 diabetes on insulin. CGMs have been shown to: (1) improve clinical quality, health outcomes, and quality of life; (2) reduce health care costs; and (3) support broader efforts by state Medicaid agencies to address disparities and related health inequities.
As of May 2023, 45 states and D.C. provide some level of CGM coverage. Yet, there is no consistent CGM policy across states, with coverage varying significantly. This fact sheet explores challenges related to CGM coverage within Medicaid and why expanding access to CGMs in Medicaid can improve diabetes care and reduce health inequities. The fact sheet provides an update to a CHCS state-by-state coverage analysis from 2022, and includes steps taken by states to reduce barriers to CGM access in Medicaid.