Posted on

California proposes expanding Medicaid coverage of continuous glucose monitors

MM Curator summary

California wants to add $12M in the next fiscal year’s budget to pay for CGM for adults with Type 1 diabetes.


The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Dive Brief:

  • California Gov. Gavin Newsom proposed providing $12 million to expand coverage of continuous glucose monitors (CGMs).
  • The 2021-22 budget proposal is intended to increase access to CGMs among adults with Type 1 diabetes who are covered by California’s Medicaid program Medi-Cal. Abbott, Dexcom, Medtronic and Senseonics compete for the U.S. CGM market.
  • Trade group AdvaMed welcomed the proposal, arguing it will reduce overall healthcare costs, and called on other states to take similar steps to ensure access to CGMs.

Dive Insight:

Sales of CGMs such as Abbott’s FreeStyle Libre and the Dexcom G6 have grown quickly in recent years as Type 1 and Type 2 diabetics have identified the devices as ways to improve the management of their conditions. However, Medicaid coverage of CGMs is patchy with some states providing no coverage and others limiting access to the pediatric population.

California was one of the states with a Medicaid program that only provided CGMs to children who met certain criteria. Lawmakers sought to expand access in 2019, only for Newsom to veto the bill. Newsom said expanded access should be considered through the annual budget process.  

State lawmakers reminded the Democratic governor of his comments about the budget process late last year, adding that the COVID-19 pandemic has emphasized the need for improved access to CGMs. The lawmakers framed CGMs as a way to control spending on adult diabetes patients. 

The pressure has paid off. Newsom wants to include $12 million in funding to enable adults with Type 1 diabetes to access CGMs in California. The funding, which is set to kick in at the start of next year, is the start of an ongoing commitment to CGMs. Newsom’s office sees CGM funding as a way to boost health equity. Overall Medi-Cal funding is set to increase more than 10% in 2021-22.

The budget proposal comes shortly after an American Diabetes Association survey found 20% of people have foregone or delayed getting a CGM or other device due to financial constraints during the COVID-19 pandemic. Among people with a CGM or insulin pump, 15% have delayed sourcing consumable supplies for the devices, typically due to financial constraints.

AdvaMed praised the funding proposal, stating Newsom “is exactly right to push for expansion of Medi-Cal’s coverage of CGMs.” The trade group said providing the Medi-Cal population with CGMs is both the right thing to do and “a smart way” to reduce healthcare costs.

The California legislature will determine whether the budget request is enacted, and the proposal will take effect Jan. 1, 2022, if approved. 


Clipped from: