As a physician who knows all too well the difficult and devastating impact of diabetes on my patients and on nearly 2.8 million Texans, I was excited to learn recently that Texas is one of only seven states nationwide to become part of a pioneering new initiative to improve diabetes care for Medicaid recipients.
The Texas Health and Human Services Commission (HHSC) was selected in late 2023 by the Center for Health Care Strategies to be part of an 18-month effort to improve access to continuous glucose monitors (CGMs) in primary care settings for Texans receiving diabetes care through Medicaid.
CGMs are used by millions of people throughout the U.S. to monitor blood glucose (blood sugar) levels and avoid complications and emergencies. Since the first CGM was approved by the Food and Drug Administration (FDA) in 1999, innovative CGM technology has become increasingly prescribed to help improve diabetes management, treatment adherence, and patient outcomes. CGM technology offers ongoing, real-time insights about blood glucose levels to people with diabetes, medical providers, and caregivers. Many CGM devices even provide an alert or alarm when blood glucose is too high or too low.
Because CGMs provide comprehensive information for ongoing diabetes management, they allow people with diabetes and medical providers to optimize diabetes treatment to reduce diabetes-related deaths, hospitalizations, and serious complications.
Though this life-changing—and lifesaving—technology can improve health outcomes and reduce acute events and downstream costs associated with diabetes complications, many Texans do not have access to CGM devices due to utilization controls and restrictive coverage policies. This is especially true for Texans in the Medicaid program.
In Texas, approximately 187,000 Medicaid recipients had a primary diagnosis of diabetes as of 2022. However, a study by the American Diabetes Association® found that CGM utilization among Medicaid beneficiaries, particularly older people, and Black and Hispanic communities, is lower than for people with diabetes who are privately insured. According to the study, Medicaid beneficiaries who take insulin were two to five times less likely to use a CGM than those with commercial health insurance coverage. This disparity in coverage is particularly troublesome, considering individuals with diabetes are at least twice as likely to receive their health care from Medicaid as those without diabetes.
“When diabetes is not appropriately monitored and managed, it can be costly to those living with diabetes and to the health care system.”
People with diabetes have medical expenses approximately 2.6 times higher than those who do not have diabetes. Total direct medical expenses for diagnosed diabetes in Texas were estimated at $18.9 billion in 2017, with another $6.7 billion spent on indirect costs from lost productivity due to diabetes.
Thankfully, the Texas HHSC has been working to update its coverage guidelines and provider procedures to align with CGM coverage guidelines established in April 2023 by the U.S. Centers for Medicare and Medicaid Services (CMS) to extend CGM coverage to those who could benefit from the devices. The revised CMS guidelines say people with diabetes should have access to CGM coverage if they have diabetes treated with insulin or a documented history of problematic hypoglycemia.
Choice of a CGM is an important consideration. People with diabetes and their medical providers should have the ability to decide which CGM will best fit individual circumstances.
Eliminating burdensome criteria and requirements in current Texas Medicaid guidelines will help the state of Texas succeed in its quest to improve diabetes care and quality of life.
The mission of the American Diabetes Association is to prevent and cure diabetes and to improve the lives of all people affected by diabetes through research, education, and advocacy.