CGMs to be Covered Under California Medicaid’s Medi-Cal
On May 18, 2021, diaTribe joined with over 30 other organizations to call on California’s Senate and Assembly leaders to support the Governor’s decision to include continuous glucose monitor (CGM) coverage for low-income people. Effective January 1, 2022, the California Department of Health Care Services will add CGMs as a covered Medi-Cal benefit for beneficiaries ages 21 and older with type 1 diabetes.
California’s Medicaid, known as Medi-Cal, will now cover continuous glucose monitors (CGMs) in an effort to address diabetes disparities. The policy update was included in the 2021-2022 budget, which the California Legislature approved on June 28.
The coming year’s budget includes $4.9 million to CGMs as a “covered Medi-Cal benefit for adult individuals with type 1 diabetes” according to a California State Legislature summary. The change will be effective January 1, 2022.
In December 2020, 23 assembly members sent a letter to Gov. Gavin Newsom, calling on him “to prioritize the inclusion of CGMs in the Medi-Cal program to reduce immediate COVID-19 risks.” They added that such coverage “‘will advance the administration’s shared objective of expanding minority health care access.”
One Assembly member in particular, Adam Gray, has been a long-time proponent of CGM coverage for people with diabetes and helped spearhead the effort. Gray originally proposed Medi-Cal CGM coverage in 2017 when he introduced Assembly Bill 447, which then Gov. Jerry Brown ultimately vetoed. In a statement regarding California’s 2021 budget proposal that included Medi-Cal coverage of CGMs, Gray said, “This cannot be overstated; chronic illness and premature death will be prevented because of this reform.”
In a comment to diaTribe, Gray said, “I began fighting for Medi-Cal coverage of continuous glucose monitors more than five years ago. I was shocked to discover Medi-Cal was the only major insurer in the state withholding this standard of care from its patients. Diabetes affects people of every income level, but our health care system treated Medi-Cal patients like second class citizens. I am so proud and thankful to the coalition of supporters, advocates, and Governor Newsom for their commitment and partnership in this effort.”
Medi-Cal & CGMs
At diaTribe Change, we believe that Medicaid coverage of CGMs help advance health equity. Medi-Cal provides health care for 12 million individuals who are low-income or have a disability. This is the nation’s largest Medicaid program. Prior to the new CGM coverage policy, Medi-Cal only covered CGMs for children who met certain requirements. This meant that adults with diabetes on Medi-Cal, and even some children, could not access the devices that could have significantly improved their health. Since diabetes disproportionately affects people who are low-income, the absence of CGM Medicaid coverage has made it challenging for many of them to get needed care.
The COVID-19 pandemic highlighted a more apparent need for accessible, affordable health care everywhere. This is especially true for the over 34 million Americans who have diabetes and are at increased risk for serious COVID-19 symptoms and complications. CGMs can help improve people’s time-in-range and reduce the risk of diabetes-related complications, but too many people cannot access CGMs due to cost barriers. The American Diabetes Association (ADA) found that during the pandemic, a vast majority of the 20% of people with diabetes who opted not to get a pump or CGM, did so because of financial constraints. Additionally, most people who rely on CGMs delayed refilling their supplies during the pandemic due to financial strain.
Diabetes in California
California has the highest number of new cases of diabetes among all states. Further, 10.1% of Californian adults have diabetes. This number does not include people who have not been officially diagnosed or who do not know that they have diabetes.
Black, Hispanic, and people of lower-income in California are disproportionately impacted by diabetes, as they are in the rest of the US. Among Black people in California, 14.4% have been diagnosed with diabetes, compared to 8% of white people. Income is also closely connected to diabetes diagnosis: in 2019, 17.6% of Californians who made less than $25,000 had diabetes, compared to only 7.2% of Californians who made $75,000 or more. It is evident that California needs to continue addressing these health disparities.
With this change, California will join the 41 other states that have included CGMs in their Medicaid coverage for adults with diabetes. While we hope that Medi-Cal eventually covers CGMs for people with type 2 as well, this is a strong step forward in making CGMs more accessible for the people who need them.
“As someone who has members of my own family who have lived with diabetes all of their lives, I know how critical CGMs have been to effectively manage their blood sugar levels,” Gray said. “Medi-Cal patients will now have access to this same life changing medical technology, and I am proud to say another immoral example of systemic equity has fallen.”
We applaud the new policy change, but more needs to be done to expand the accessibility of CGMs and advance health equity. Like in California, 21 other state Medicaid programs only cover CGMs for people with type 1 diabetes despite the millions of type 2s who could benefit. Further, six state (and DC) Medicaid programs do not cover CGMs for any adults with diabetes.
Too many people with diabetes experience harmful health complications because they do not have the resources to help manage the disease. Every person with diabetes deserves the opportunity to get a CGM and have access to the tools that can help them live healthier, happier lives. diaTribe Change will continue to amplify the voices of people with diabetes in advocating for CGM access.