Prediabetes and diabetes present significant health and fiscal challenges in Texas. More than seven million adults in the state have prediabetes, and 13.2 percent have diagnosed diabetes. Diabetes-related health care costs for Texas Medicaid members may reach $8.1 billion annually, representing nearly 21 percent of total Medicaid spending.

The CDC’s National Diabetes Prevention Program (National DPP) is a lifestyle change program that supports healthier eating, physical activity, and long-term behavior change for adults with prediabetes or other elevated diabetes risk factors. Evidence shows that the program can help prevent or delay type 2 diabetes, support modest weight loss, and generate health care savings over time.

Many states have adopted Medicaid coverage for the National DPP through State Plan Amendments, Section 1115 demonstrations, and Medicaid managed care pilots. These approaches offer lessons for Texas as it considers how to design a Medicaid benefit that supports prevention, strengthens community-based delivery, and aligns with state population health and fiscal sustainability goals.

With support from Episcopal Health Foundation, the Center for Health Care Strategies conducted a literature review and key informant interviews with Medicaid and public health officials, National DPP implementation partners, and other experts. The report summarizes coverage pathways, benefit design options, provider enrollment considerations, delivery and reimbursement models, technical assistance needs, evaluation approaches, and evidence on program outcomes. While focused on the Texas context, the report includes lessons for other states exploring Medicaid coverage of the National DPP or seeking to strengthen preventive services for Medicaid members at risk of developing type 2 diabetes.