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Providing Diabetes Health Coverage: State Laws & Programs

A policymaker and consumer guide to state insurance mandated coverage, Medicaid coverage and state-sponsored diabetes programs

Updated: July 14, 2009; material added November 12, 2009

Nearly 24 million people in the United States have diabetes, equal to 7.8 percent of the total population. According to the Centers for Disease Control and Prevention (CDC) this represents an increase of more than 3 million people in approximately two years. The CDC data report released in June 2008 confirmed that diabetes is the largest and fastest-growing chronic disease in the nation.

Diabetes is characterized by a condition where the body does not produce or properly use insulin. Insulin is necessary to covert sugar, starches and other foods into energy for lving. Among the types of diabetes,

Type 1 diabetes is usually diagnosed in children and young adults and was previously known as juvenile diabetes. Insulin shots are the only way to keep blood glucose levels down in Type 1 diabetes sufferers.

Type 2 diabetes, wihich is the most common form of diabetes, causes the body to not produce enough insulin or causes the cells to ignore the insulin.

Gestational diabetes occurs when pregnant women who have never had diabetes before have high blood sugar (glucose) levels during pregnancy. Gestational diabetes requires pregnant women to manage their condition during pregnancy to deliver a healthy child. The condition is temporary and usually reverses after the child's birth. However, women who develop the condition are at a higher risk of developing diabetes later in life.

A leading cause of blindness, kidney disease, heart disease and amputations, diabetes also claims the lives of more than 193,000 Americans each year. According to the CDC, it was the country's seventh leading cause of death by disease in 2006.

Diabetes is treatable. Although there is no "cure" various treatments allow most diabetics to live relatively stable, normal lives. Early screening, diagnosis and treatment also prevent or reduce the more serious consequences of the disease — emergency room visits, hospitalization, loss of sight, loss of limbs.

Once diagnosed, diabetes requires self-management, including testing and monitoring blood glucose levels. Because treatment requires patient education, special equipment and supplies, it can become costly especially when it is not covered by health insurance.

The Role of State Laws: States have recognized the major effects diabetes plays, both in its impact on patients and on society. As of mid-2009, 46 states and the District of Columbia have some law that requires health insurance policy coverage for diabetes treatment. Laws in Mississippi, Missouri and Washington require only that insurers offer coverage, but not necessarily include the coverage in all active policies. Most states require coverage for both direct treatment and for diabetes equipment and supplies that are often used by the patient at home. The four states that do not have a mandate or insurance requirement are Alabama, Idaho, North Dakota and Ohio. State tables include the enacted state laws passed since the first California mandates in 1981 and New York's in 1993, through early 2009.

What this Report Covers

All state law diabetes mandates and minimum coverage requirements for state-regulated health insurance policies. The tables include the enacted state laws passed since the first mandates in California (1981) and New York (1993.)

Find Your State: An Interactive Map [NEW]

All state Medicaid diabetes coverage terms and conditions. [description]

All Children's Health Insurance Program (CHIP) diabetes coverage.

Contact information and an overview of federal funding provided by the Centers for Disease Control and Prevention (CDC) to state-sponsored diabetes prevention and control programs (DPCPs). DPCPs represent the front line in battling diabetes in most states.

An overview of other state activities and initiatives, such as creation of diabetes coordinator positions in the executive branch to fight diabetes.

Economic Costs of Diabetes in the United States The estimated total cost of diabetes in 2007 was $174 billion:

Includes $116 billion in excess medical expenditures and $58 billion in reduced national productivity

$27 billion for care to directly treat diabetes

$58 billion to treat the portion of diabetes-related chronic complications that are attributed to diabetes

$31 billon in excess general medical costs

A study commissioned by the National Changing Diabetes Program added to the existing estimate the costs for undiagnosed diabetes, pre-diabetes and gestational diabetes to bring the total to $218 billion in 2007. Furthermore, by 2025, the number of people with diabetes is expected to double, placing increased demands on the healthcare system and creating opportunities for more integrated and innovative disease management.

Some Diabetes Statistics

On May 7, 2008 the National Changing Diabetes Program released the findings of a Gallup survey assessing the public’s knowledge, perceptions and behaviors regarding diabetes. Some findings include:

Nine percent of people polled have been diagnosed as having diabetes. 15 percent have been diagnosed as "at risk" for diabetes

47 percent of adults feel they could be at risk for diabetes, though they are not diagnosed

96 percent of Americans feel that this serious medical and social problem rivals AIDS, cancer and heart disease

National Institute of Diabetes
and Digestive and Kidney Diseases

Source: American Diabetes Association

Obesity and Diabetes

Obesity in persons with diabetes is associated with poorer control of blood glucose levels, blood pressure and cholestrol, placing persons with diabetes at higher risk for both cardiovascular and microvascular disease. A 2002 CDC study of the prevalence of obesity among individuals diagnosed with diabetes showed that 57.9% of non-Hispanic whites diagnosed with diabetes were also obese. This figure was 63.0% for non-Hispanic blacks, and 59.5% for Mexican Americans. Weight management, through healthy eating and physical activity, can help reduce the number of persons at risk for diabetes and reduce the risk for complications and premature mortality among those who already have diabetes. NCSL has a 2009 special project on obesity, available at http://www.ncsl.org/Default.aspx?tabid=14339

Diabetes and Native Americans

Diabetes affects American Indians/Alaska Natives (AI/ANs) disproportionately compared with other racial/ethnic populations and has been increasing in prevalence. The CDC estimates that prevalence of diabetes for AI/AN adults is more than twice that of U.S. adults overall. A CDC study in 2003 showed about 16.5% of American Indians and Alaska Natives aged 20 years or older who received care from the Indian Health Service (IHS) in 2003 had diabetes. The rates of diabetes vary within this population with diabetes being diagnosed at 6% among Alaska Native adults and 29.3% among Native American adults in Southern Arizona.
The U.S. Congress established the Special Diabetes Program for Indians (SDPI) in 1997. The SDPI provides funding for diabetes treatment and prevention services at 399 IHS, Tribal and Urban Indian health programs in the 12 IHS areas in 35 states across the United States. IHS has used these funds to establish approximately 350 new diabetes programs in AI/AN communities. In 1998, CDC and IHS established the National Diabetes Prevention Center in Gallup, New Mexico, to provide guidance and technical support to AI/AN communities throughout the United States and to develop, evaluate, and disseminate culturally appropriate interventions. More information on the work of IHS with regard to diabetes treatment can be found online at: http://www.ihs.gov/MedicalPrograms/diabetes/. Some states with sizeable Native American populations supplement IHS programs with additional resources and programs.

Pre-Diabetes Before an individual develops type 2 diabetes, he or she almost always has "pre-diabetes". In this condition, blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes. Fifty-seven million people in the United States have pre-diabetes. Research shows that, when individuals with pre-diabetes take action to manage their blood glucose, they can delay or prevent type 2 diabetes from developing.

State and Federal Requirements for Coverage

Laws in 46 states and the District of Columbia require private market health insurance coverage or offerings for people enrolled in a health plan and diagnosed with diabetes. Most individuals with diabetes had coverage through private insurance (39 percent) or Medicare (44 percent). Eleven percent of diagnosed diabetics under the age of 65 were uninsured and most likely to be from low income backgrounds. Diabetics covered in the private insurance market generally belong to employer-sponsored group health plans or individual health plans. Employer-sponsored group health plans are the most popular because coverage is subsidized and often offer higher protection. Those under age 65 whose job or family member's job does not offer such coverage usually must rely on the "individual insurance market." They may have difficulties finding affordable plans that will accept them, especially if they have a pre-existing chronic disease such as diabetes.
In some circumstances where individuals may not be covered, or may not be fully covered, for diabetes treatment despite living in a "mandate" state. These include enrollment in: 1) a "high-deductible health plan (HDHP) often combined with a "health savings account" (HSA) in which the enrollee must pay 100 percent of treatment costs until he or she reaches a "deductible" level -- often an amount of at least $1,150 annually, and in some cases as high as $10,000 annually. 2) special "mandate light" or mandate-exception policies aimed at special populations such as workers for small employers. 3) Bare bones or "capped benefit" insurance policies that may limit coverage to a set dollar amount per year.

State Roles Limited by ERISA State health insurance laws apply to about 45 percent of all private market health policies - those "fully insured plans" in which mostly small and medium sized businesses pay premiums. Federal ERISA law applies to the other 55 percent of policies that are sometimes called "self-insured plans." Some 73 million American workers and their dependants were covered by self insured plans in 2007 - that is, policies in which the employer assumes the financial risk for providing health care benefits to its employees, rather than buying insurance. There is no federal law mandate for diabetes insurance coverage. (Source: Employee Benefit Research Institute, February 2008).

Medicare is the federal program that covers both the majority of those over age 65 and people with disabilities. A summary follows of diabetes-specific beneftis for relevant Medicare components.

Medicare Part B, an optional service with a modest monthly premium (set at $93 per month in 2009), provides coverage for physician visits, diabetes screening, diabetes self-management training and nutrition counseling services, lab testing, diabetes glucose testing supplies, and insulin pumps and associated supplies. Medicare information describing available diabetes coverage is online at www.medicare.gov/health/diabetes.asp.
For people with Medicare Part B who are at risk for getting diabetes, Medicare covers a screening blood sugar test to check for diabetes. Medicare considers an individual at risk if he or she has any of the following: high blood pressure, history of abnormal cholestrol and triglyceride levels (dyslipidemia), obesity, or a history of high blood sugar. Other risk factors may also qualify enrollees for this test and based on the results, they may be eligible for up to two screenings each year.
Medicare Part D is a separate optional coverage that provides a relatively consistent level of prescription drug coverage. Begun in 2006, the plans provide coverage for prescription drugs, including insulin, insulin pens and syringes. Part D Prescription Drug Plans (PDPs) are provided by commercial insurers and are allowed considerable variation in their Medicare enrollee charges. The "base beneficiary premium" for 2009 is $30.36 per month according to the Centers for Medicare and Medicaid Services. In practice, premiums vary significantly from one Part D plan to another. The Part D benefits may also be subject to a coverage gap or "donut hole" for any prescription drug purchases between $2,700 and $6,154; the program has a maximum out-of-pocket enrollee share of $3,453.75 in 2009. Approximately 20 states provide some financial help to certain low and moderate income residents enrolled in this part of the Medicare program.
NCSL has a web-based report with details on the states that provide some subsidies for Part D prescription drug policies. The NCSL report is available at http://www.ncsl.org/default.aspx?tabid=14334.
Low-income Medicare enrollees who also are eligible for Medicaid, known as "dually eligible," often are entitled to significantly smaller out-of-pocket payments.
The Medicare Program federal website has specific information for diabetes treatment, available at www.medicare.gov/Health/Diabetes.asp

Medicaid covers the health care needs for qualified low-income people and those who have few resources. There are special expanded eligibility terms for pregnant women. Medicaid is jointly funded by the federal and state governments; coveraged populations and benefits vary among states. As a condition for receipt of federal funding, states must provide certain services, such as in- and out-patient care, doctor visits and long-term care. While services such as prescription drugs are optional under federal law all states and territories have chosen to include them. Other details of benefits such as prescribed insulin, disposable needles, syringes, monitors and blood glucose strips are determined by each state's Medicaid policy and are listed by state.

The Children's Health Insurance Program (CHIP) The Children's Health Insurance Program - formerly known as SCHIP (the State Children's Health Insurance Program) - has become the nation's primary source of coverage for uninsured children who do not qualify under Medicaid. In 2008, 7.4 million children received health coverage through CHIP. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) passed in April 2009 both extended and expanded CHIP through September 2013. The federal government covers about 70 percent of the programs' cost nationwide with state goverenments picking up the rest of the cost. Diabetes treatment and management is available to children enrolled through the CHIP program. Diabetes treatment options are comparable to those available under Medicaid in most states, although patients may be responsible for higher payments and care defined as diabetes education services.

OTHER DIABETES PROGRAMS AND ACTIVITIES

State - Based Diabetes Prevention and Control Programs The Centers for Disease Control and Prevention (CDC) provides financial assistance and support to states to improve health care services for preventing, detecting and treating diabetes and its related complications. This assistance is provided in the form of grants to State Diabetes Prevention and Control Programs (DPCPs) that typically are housed within departments that oversee health programs in a given state. DPCPs often represent the front-line of efforts to prevent, manage and control the reach of diabetes. States must apply to CDC annually for available DPCP funds.
Appropriations made available to CDC in FY 2009 provided $27,444,988 in grants to all DPCPs in the United States and Puerto Rico. About another $900,000 was made available to the territories and the U.S. Virgin Islands for FY 2009. The FY 2009 grants amounted to a 4.3 percent reduction in funds available during FY 2008. This reduction occurred due to limited funding during a time when CDC data documented that the number of people continued to grow nationwide.
Beginning in FY 2009, the CDC finalized new five-year cooperative agreements with all 50 states, the District of Columbia, Puerto Rico and the territories for DPCPs. These agreements established a new funding formula for DPCP grants. This formula weights grant applications based on the total population living with diabetes (60 percent weight) and the percentage of people with diabetes (40 percent weight) within a state or territory. According to the CDC, distributing funds under the new formula allows greater equity and distribution of money to states and territories that have higher percentages of people living with diabetes.
The range of grants available to states and territories in FY 2009 was between $202,000 and $1,043,000. The limited funding appropriated, coupled with the new distribution formula for grants, led most states to experience a reduction in grants provided to DPCPs in FY 2009.
State governments are required to supplement DPCP grants by contributing at least $1 for every $4 provided. An early 2009 assessment found that most states and territories do not provide separate funding for this purpose. Although several states - including Kentucky, Michigan, New Mexico, New York and Texas - provide significant financial resources to supplement DPCP grants, state assistance is to the programs is less certain due to the current budget crisis.

State Diabetes Coordinators To bring greater efficiences across state departments by aligning resources and objectives, several states have considered creating a state diabetes coordinator. Tennessee, under the direction of Governor Bredesen, the Legislature and the state Health Department Commissioner Susan Cooper, created the nation's first state-wide Diabetes Coordinator. The TN legislation to create a state diabetes coordinator within the department of Health was enacted into law on 5/12/08 (SB 1252). Other state level proposals include a bill introduced in Georgia in 2007 by Senator Balfour (SB 505), now signed into law as Act 102 in May 2009; and bills filed in New York by Assembly member Ortiz (A 6949) and Senator Montgomery (S 5272) in May 2009. Federal legislation to create a National Diabetes Coordinator was introduced in Congress in 2008 (HR 4836).

Figure 1. State Diabetes Coverage Requirements within Private Insurance

Map data updated September 2009 based on NCSL research.

Links to individual state facts and resources:
AL l AK l AZ l AR l CA l CO l CT l DE l DC l FL l GA l HI l ID l IL l IN l IA l KS l KY l LA l ME l MD l MA l MI l MN l MS l MO l MT l NE l NV
l NH l NJ l NM l NY l NC l ND l OH l OK l OR l PA | PR l RI l SC l SD l TN l TX l UT l VT l VA l WA l WV l WI l WY l

Coverage

Coverage for Supplies and Equipment

For diabetics, coverage of prescription medications - including insulin, medical supplies such as insulin syringes, and equipment such as blood glucose monitors - is essential to medical treatment. Under the Texas Insurance Code, for example, equipment includes blood glucose monitors, including noninvasive glucose monitors and glucose monitors designed to be used by the blind; insulin pumps and associated equipment; insulin infusion devices; and podiatric appliances to prevent complications associated with diabetes. Supplies include test strips for blood glucose monitors; visual reading and urine test strips; lancets and lancet devices; insulin and insulin analogs; injection aids; syringes; prescriptive and nonprescriptive oral agents to control blood sugar levels; and glucagon emergency kits. In most state legislatures, however the two terms are used interchangeably and may not be defined. Some states have issued regulatory guidelines further defining the terms.

Coverage for Artificial Limbs (Prosthetic Devices)

Approximately 2 million Americans have lost a limb, and many cases are attributed to complications of diabetes that lead to amputation. As of December 2008, there are 14 states that have passed legislation pertaining to the coverage of prosthetic / orthotic devices — California (must offer, 2006), Colorado (2000), Connecticut (1987), Indiana (2008), Louisiana (2008), Maine (2003), Maryland (1999), Massachusetts (2006), Michigan (1986), New Hampshire (2004), New Jersey (2008), Oregon (2007), Rhode Island (2006), and Vermont (2008) — . In 13 states the legislation requires an insurer to cover prosthetic devices under its policy, as it would any other medical procedure; in California insurers must offer at least one policy that includes orthotics/prosthetics but other policies can exclude them.

National Statistics on Diabetes

Prevalence of Diagnosed and Undiagnosed Diabetes in the United States, All Ages, 2007

23.6 million people—7.8 percent of the population—have diabetes.

Diagnosed: 17.9 million people
Undiagnosed: 5.7 million people
By 2025, it is estimated that 50 million people will be living with diabetes.
One in three boys and two in five girls born in 2000 are at risk to develop diabetes in their lifetimes.

Prevalence of Diagnosed and Undiagnosed Diabetes among People Aged 20 Years or Older, United States, 2007

Age 20 years or older: 23.5 million, or 10.7 percent, of all people in this age group have diabetes.
Age 60 years or older: 12.2 million, or 23.1 percent, of all people in this age group have diabetes.

Men: 12.0 million, or 11.2 percent, of all men aged 20 years or older have diabetes.
Women: 11.5 million, or 10.2 percent, of all women aged 20 years or older have diabetes.

Non-Hispanic whites: 14.9 million, or 9.8 percent, of all non-Hispanic whites aged 20 years or older have diabetes.
Non-Hispanic blacks: 3.7 million, or 14.7 percent, of all non-Hispanic blacks aged 20 years or older have diabetes.

Sources: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Diabetics Statistics, 2007, http://diabetes.niddk.nih.gov/dm/pubs/statistics/#allages; Diabetes Care Journal, vol. 32, no.2, February 2009, pp. 290.

Diabetes Management and Treatment Products

Examples of brand-name and generic products prescribed and used for diabetes management and treatment.

Supplies/Equipment	Examples of widely-used Brands and types
Insulin Syringes	BD Ultrafine, Levemir^®, Monoject, NovoFine^®, Ulticare, UniFine, UltiGaurd
Insulin	Apidra, Humulin, Lantuo, Lente, Levemin, Novolog, Novolin, NPH Insulin, Regular Iletin, Regular Insulin, Velosulin
Insulin Pumps	Animas, Deltec, Medtronic
Blood Glucose Test Meters and Test Strips	Abbott Freestyle^®, Abbott Flash, Accu-Chek Compact^®, Ascensia Elite, Ascencia Breeze, Ascensia Contour, Lifescan One-Touch©, Prestige
Oral Medications (these drugs act in different ways to lower blood glucose levels and may be prescribed in combination with other medication)	Acarbose, Avandia, Chlorpropamide, Diabinese, Glipizide, Glucophage, Glucotrol, Gylset, Meglitol, Metformin, Prandin, Precose, Repaglinide, Rosiglitazone

Examples of insulin pens and products

Illustration
© Novo-Nordisk

KEY/DEFINITION

TERM	DEFINITION
Blanket Health Insurance Policy	Normally, a health insurance policy that covers a group of individuals such as employees of an organization, students at a school, members or a labor union, etc.
Copayment	A fixed dollar amount that must be paid by an insured individual each time a medical service is accessed before the insurance company provides its share of the medical expenses.
Deductibles	A fixed dollar amount that must be paid by an insured patient, normally during an annual period, before the insurance company pays the cost of medical services.
Diabetes Education	Includes formal training on prevention and management of diabetes, with scheduled follow-up and screening.
Durable medical equipment	Term used to describe certain insurance related benefits such as wheelchairs, oxygen tent, hospital beds, etc. However, the term generally includes insulin pumps, insulin pump supplies, blood glucose meters, blood glucose meter test strips and other day-to-day diabetes management needs.
Federal Poverty Level (FPL)	An eligibility benchmark, officially the "Federal Poverty Guideline," set annually by the U.S. Department of Health and Human Services and used by many states and federal programs to determine if residents are eligible to be enrolled, based on annual income. Maximum eligibility levels often are set at a percentage of "FPL", such as 150 percent or 200 percent. For 2009, the official FPL was $10,830 for an individual, $14,570 for a two person household and $3,740 for each additional household member.
Gestational Diabetes	Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women - about 135,000 cases of gestational diabetes in the United States each year.
Glycemic control	Refers to the typical and changing levels of blood sugar in a person with diabetes.
Interdialytic parenteral nutrition	Nutrition provided to diabetes patients during dialysis.
Lancing and Lancet Devices	A blood-sampling device used by diabetics to draw blood from a fingertip or other area to monitor blood glucose levels.
Medical Nutrition Therapy	Nutritional diagnostic, therapeutic, and counseling services provided by a registered dietitian.
Medigap	Refers to the various private supplemental health insurance plans sold to Medicare beneficiaries that provide coverage for medical expenses not or only partially covered by federal Medicare.
National Diabetes Educational Program (NDEP)	NDEP is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with the support of more than 200 partner organizations. NDEP works to translate and spread the latest science on diabetes to the public.
Orthotic Insert or Orthotics	Refers to procedures dealing with the support and bracing of weak or ineffective joints and muscles. For people with diabetes this can include specially designed shoes aimed to reduce the risk of a lower leg amputation to more involved prosthetic devices.
Subscription Contracts	A contract between a corporation and its subscribers to provide certain medical services.

State Insurance and Medicaid Coverage Requirements and Programs

Alabama

Number of Residents with Diabetes by Age group

State Population¹

Age Birth to 19²

Age 18 to 44

Age 45 to 64

Age 65 to 74

Age 75+

Total State Population with Diabetes³

Number of People covered by Health Insurance⁴

4,627,851

2,500

49,000

137,000

71,000

47,000

307,500

4,021,000

State laws and regulations

No applicable statute. Alabama is one of four states that does not have a mandate or insurance requirement specific to diabetes coverage.

Benefits required

Medication - No
Equipment- No
Supplies - No
Education - No
Services - No

Medicaid⁵

CHIP

Prescribed Insulin
Disposable Needles Syringe Combinations Blood Glucose Strips

Covered* Covered Covered Covered

Covered Covered Covered Covered

* Covered with restrictions: prescribed insulin and syringe combinations used for insulin (on preferred drug lists (PDL) and maximum units apply) and intradialytic parenteral nutrition (certification of medical necessity on script).
** Requires a copay depending on fee group (based on fee group according to FPL); no fee for Native American patients.

Diabetes Prevention & Control Programs

Alabama Diabetes Prevention and Control Program, Bureau of Health Promotion & Chronic Disease.
http://www.adph.org/diabetes/

Alaska

Number of Residents with Diabetes by Age group

State Population¹

Age Birth to 19²

Age 18 to 44

Age 45 to 64

Age 65 to 74

Age 75+

Total State Population with Diabetes³

Number of People covered by Health Insurance⁴

683,478

400

3,000

11,000

3,000

2,000

20,400

552,000

State laws and regulations

Alaska statute: Alaska ST §21.42.390 Date enacted: 2000

Insurance policies required to provide coverage

All health care insurance plans must include coverage for outpatient self-management training and education and medical nutrition therapy. A health care insurance plan that includes coverage for pharmacy services must provide coverage for the cost of treating diabetes, including medication, equipment and supplies.

People covered by insurance mandate; Exceptions

- Insulin-dependent diabetes
- Insulin-using diabetes
- Gestational diabetes
- Non-insulin-using diabetes

Benefits required

Medication	Yes	Not specified.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Medical nutrition therapy included, if diabetes treatment is prescribed by a health care provider.
Services	Yes	Coverage for outpatient self-management training.

Copayments/deductibles

Coverage is subject to standard policy provisions applicable to other benefits, including deductible or copayment provisions.

Special features and issues

- Coverage for the cost of diabetes outpatient self-management training or education and for the cost of medical nutrition therapy is required only if provided by a health care provider trained in diabetes treatment of diabetes.
- Alaska requires coverage for medical nutritional therapy, equipment and supplies only when the contract or insurance policy has prescription drug coverage.

Statute Web Link:

http://www.legis.state.ak.us/cgi-bin/folioisa.dll/stattx03/query=*/doc/%7b@9330%7d?

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered**	Covered**	Covered**
Covered	Covered	Covered	Covered

**Covered as durable medical equipment

Diabetes Prevention & Control Programs

Alaska Diabetes Prevention and Control Program
http://www.hss.state.ak.us/dph/chronic/diabetes/default.htm

Arizona	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
6,338,755	4,000	66,000	108,000	71,000	48,000	299,000	5,204,000

State laws and regulations

Arizona statute: ST §20-2325: Diabetes equipment, supplies; ST §20-826, Subscription contracts; ST §20-1057: Evidence of coverage by health care services organizations, renewability; ST §20-1342: Scope and format of policy; ST §20-1402: Provisions of group disability policies; ST §20-1404: Blanket disability insurance.
Date enacted: 1998

Insurance policies required to provide coverage

Hospital, medical, dental and optometric service corporation contracts; health care service organizations; disability insurance group and blanket disability insurance plans must include coverage for diabetes treatment, outpatient self-management training and education.

People covered by insurance mandate; Exceptions

Patients with diabetes; type of diabetes not specified.

Benefits required

Medication	Yes	Not specified.
Equipment and supplies	Yes	1. Blood glucose monitors. 2. Blood glucose monitors for the legally blind. 3. Test strips for glucose monitors and visual reading and urine testing strips. 4. Insulin preparations and glucagon. 5. Insulin cartridges. 6. Drawing up devices and monitors for the visually impaired. 7. Injection aids. 8. Insulin cartridges for the legally blind. 9. Syringes and lancets including automatic lancing devices. 10. Prescribed oral agents for controlling blood sugar that are included on the plan formulary. 11. To the extent coverage is required under Medicare, podiatric appliances for prevention of complications associated with diabetes. 12. Any other device, medication, equipment or supply for which coverage is required under Medicare from and after Jan 1, 1999. The coverage required in this paragraph is effective six months after the coverage is required under Medicare.
Education	No
Services	No

Copayments/deductibles

Nothing prohibits a group disability insurer from imposing deductibles, coinsurance or other cost sharing in relation to benefits for equipment or supplies to treat diabetes.

Special features and issues

Arizona requires coverage of equipment and supplies only when the insurance policy covers expenses incurred to treat diabetes.

Statute Web Link:

http://www.azleg.gov/FormatDocument.asp?inDoc=/ars/20/02325.htm&Title=20&DocType=ARS

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

Arizona Diabetes Control & Prevention Coordinator, Arizona Department of Health Services.
http://www.azdiabetes.gov/

Arkansas	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
2,834,797	1,600	24,000	77,000	32,000	23,000	157,600	2,354,000

State laws and regulations

Arkansas statutes: ST §23-79-601: Definitions; ST §23-79-602: Diabetes self-management training licensed providers; prescription by physician; ST §23-79-603: Requirements; ST §23-79-604: Exclusions; ST §23-79-605: Regulations; ST §23-79-606: Applicability – Delivery within state; ST §23-79-607: Applicability – Exceptions
Date effective: Aug 1, 1997

Insurance policies required to provide coverage

“Health insurance policy” means a group insurance policy, contract or plan or an individual policy, contract or plan that provides medical coverage on an expense incurred, service or prepaid risk-sharing basis.

People covered by insurance mandate

- Type I diabetes
- Type II diabetes
- Gestational diabetes

Benefits required

Medication	n/a	Not mentioned.
Equipment and supplies	Yes	1. Blood glucose monitors, which include all commercially available blood glucose monitors designed for patient use and for those who have been diagnosed with diabetes. 2. Blood glucose monitors for the legally blind, which include all commercially available blood glucose monitors designed for patient use with adaptive devices and for those who are legally blind and have been diagnosed with diabetes. 3. Test strips for glucose monitors, which include all test strips approved by the Federal Food and Drug Administration, glucose control solutions, lancet devices, and lancets for monitoring glycemic control. 4. Visual reading and urine testing strips, which include visual reading strips for glucose, urine testing strips for ketones, or urine test strips for both glucose and ketones. Urine test strips for glucose only are not acceptable as the sole method of monitoring. 5. Insulin, which includes all commercially available insulin preparations including insulin analog preparations available in either vial or cartridge. 6. Injection aids, which include devices used to assist with insulin injection. 7. Syringes, which include insulin syringes, pen-like insulin injection devices and pen needles for pen-like insulin injection devices. 8. Insulin pumps as prescribed by the physician and appurtenances thereto, which include insulin infusion pumps and supplies such as skin preparations, adhesive supplies, infusion sets, cartridges, batteries and other disposable supplies needed to maintain insulin pump therapy. These include durable and disposable devices used to assist in the injection of insulin. 9. Oral agents for controlling the blood sugar level, which are prescription drugs. 10. Podiatric appliances to prevent of complications associated with diabetes, which include therapeutic molded or depth-inlay shoes, replacement inserts, preventive devices, and shoe modifications for prevention and treatment. 11. Glucagon emergency kits and injectable glucagon.
Education	Yes	Medical nutritional therapy included.
Services	Yes	Self-management training.

Copayments/deductibles

Deductibles, coinsurance, other patient cost-sharing amounts or out-of-pocket limits or prior authorization or other utilization review requirements or processes will remain consistent with those established for other services covered by a given health insurance policy.

Statute Web Link:

http://www.arkansas.gov/asbp/pdf/lawbook03/Stat_Insurance_Policies.pdf

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered with restrictions	Covered with restrictions	Covered with restrictions	Not covered
Covered	Covered	Not Covered	Covered

Diabetes Prevention & Control Programs

Arkansas, Diabetes Control Program, Arkansas Department of Health.
http://www.healthyarkansas.com/services/services_diabetes.html

California	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
36,553,215	21,000	337,000	824,000	396,000	312,000	1,889,000	29,682,000

State laws and regulations

California Statutes: HLTH & S §1367.51: Diabetes supplies and equipment; INS §10176.6: Insurance Coverage; INS §10176.61; INS §10177.7
Date enacted: Sept. 30, 2000.

Insurance policies required to provide coverage

Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered or renewed on or after Jan 1, 2000, and that covers hospital, medical or surgical expenses.

People covered by insurance mandate; Exceptions

- Insulin-using diabetes
- Non-insulin-using diabetes
- Gestational diabetes

Benefits required

Medication	Yes	1. Insulin. 2. Prescriptive medications to treat diabetes. 3. Glucagon.
Equipment and supplies	Yes	1. Blood glucose monitors and blood glucose testing strips. 2. Blood glucose monitors designed to assist the visually impaired. 3. Insulin pumps and all related necessary supplies. 4. Ketone urine testing strips. 5. Lancets and lancet puncture devices. 6. Pen delivery systems to administer insulin. 7. Podiatric devices to prevent or treat diabetes-related complications. 8. Insulin syringes. 9. Visual aids, excluding eyewear, to help the visually impaired with proper dosing of insulin.
Education	Yes	Medical nutritional therapy included.
Services	Yes	- Diabetes outpatient self-management training - Benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to avoid frequent hospitalization and complications
Coverage for Amputees	Yes, offer	Insurers must offer at least one policy with this choice; See below under "Special features and issues" for more detailed information.

Copayments/deductibles

The copayments and deductibles for the benefits specified in “equipment” and “medication” shall not exceed those established for similar benefits within the given plan. The copayments for the benefits specified in “services” shall not exceed those established for physician office visits by the plan.

Special features and issues

Coverage for amputees: 1367.18: Every health care service plan, except a specialized health care service plan, that covers hospital, medical or surgical expenses on a group basis shall offer coverage for orthotic and prosthetic devices and services.

Statute Web Link:

http://www.leginfo.ca.gov/pub/99-00/bill/sen/sb_2051-2100/sb_2094_bill_20000930_chaptered.pdf

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

California Diabetes Program, California Department of Public Health.
http://caldiabetes.org/

Colorado	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
4,861,515	2,600	28,000	70,000	31,000	27,000	159,600	4,077,000

State laws and regulations

Colorado Statute: ST §10-16-104 (subsection 13): Mandatory coverage provisions; ST § 10-16-105: Small group sickness and accident insurance, guaranteed issue, mandated provisions for basic health benefit plans, rules, benefit design advisory committee.
Date enacted: 1998

Insurance policies required to provide coverage

Any health benefit plan, except supplemental policies that cover a specified disease or other limited benefit, that provides hospital, surgical or medical expense insurance shall provide coverage for diabetes.

People covered by insurance mandate

“Patient with diabetes” means a person with elevated blood glucose levels who has been diagnosed as having diabetes by an appropriately licensed health care professional.

Benefits required

Medication	n/a	Not mentioned.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Medical nutrition therapy included.
Services	Yes	Outpatient self-management training.
Coverage for Amputees	Yes	See below under "Special features and issues" for more detailed information.

Copayments/deductibles

Benefits are subject to the same annual deductibles or copayments established for all other covered benefits within a given policy. Private third-party payers shall not reduce or eliminate coverage due to the requirements of this law.

Special features and issues

Coverage for Amputees: §10-16-104 (subsection 14): Any health benefit plan, except supplemental policies that cover a specified disease or other limited benefit, that provides hospital, surgical or medical expense insurance shall provide coverage for benefits for prosthetic devices that equal those benefits provided for under federal law for health insurance for the aged and disabled.

Statute Web Link:

http://www.michie.com/colorado/lpext.dll/cocode/1196f/14b1f/14b21/14be6/14cd4?f=templates&fn=document-frame.htm&q=Diabetes&x=Advanced&2.0#LPHit1;

Medicaid⁵

CHIP

Disease Management/Patient Education Program includes diabetes under the program Diabetes Disease Management.
Program administrator: McKesson Health Solutions Inc.

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered**	Covered**	Covered**
Covered	Covered	Covered	Covered

**Covered as durable medical equipment

Diabetes Prevention & Control Programs

Colorado Diabetes Prevention and Control Program, Colorado Department of Public Health and Environment.
http://www.cdphe.state.co.us/pp/diabetes/index.html

Connecticut	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
3,502,309	3,200	27,000	70,000	34,000	33,000	170,200	3,150,000

State laws and regulations

CT ST §38a-492d: Mandatory coverage for diabetes testing and treatment; CT ST §38a-492e: Mandatory coverage for diabetes outpatient self-management training; CT ST §38a-518d: Mandatory coverage for diabetes testing and treatment; CT ST §38a-518e: Mandatory coverage for diabetes outpatient self-management training.
Date enacted: 1999

Insurance policies required to provide coverage

Each individual health insurance policy that provides coverage delivered, issued for delivery or renewed in this state on or after Oct 1, 1997, shall provide coverage for laboratory and diagnostic tests for all types of diabetes.

People covered by insurance mandate; Exceptions

- Insulin-dependent diabetes
- Insulin-using diabetes
- Gestational diabetes
- Non-insulin-using diabetes

Benefits required

Medication	Yes	Not specified.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Medical nutrition therapy included.
Services	Yes	Outpatient self-management training; initial training visits provided to an individual after the initial diagnosis of diabetes.

Copayments/deductibles

Benefits shall be subject to the same terms and conditions applicable to all other benefits under such policies.

Special Features and Issues

CT law (CT Sec. 38a-523) requires an insurer to cover prosthetic devices under its policy, as it would any other medical procedure. Enacted in 1987.

Statute Web Link:

http://cga.ct.gov/2007/pub/Chap700c.htm

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

Connecticut Diabetes Prevention and Control Program, Connecticut Department of Public Health.
http://www.ct.gov/dph/cwp/view.asp?a=3135&q=397524

Delaware	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
864,764	500	11,000	19,000	11,000	8,000	49,500	766,000

State laws and regulations

Delaware Code: 18§3344: Health Insurance Coverage; 18§3560: Insurance coverage for diabetes.
Date enacted: June 2000

Insurance policies required to provide coverage

Every individual or group hospital service corporation contract, individual or group medical service corporation contract, individual or group health service corporation contract, individual health insurance policy, group health insurance policy, and contract for health care services that provides hospital, outpatient services, or medical expense benefits and provides coverage for prescription drugs and that is delivered, issued, executed, or renewed in this State pursuant to Title 18 of the Delaware Code or is approved for issuance or renewal in this State by the Insurance Commissioner shall provide benefits to any subscriber or other person covered there under for expenses incurred for the following equipment and supplies for the treatment of diabetes, if recommended in writing or prescribed by a physician.

People covered by insurance mandate; Exceptions

Type of diabetes not specified.

Benefits required

Medication	Yes	1. Pharmacological agents for controlling blood sugar 2. Insulin
Equipment and supplies	Yes	1. Insulin pumps 2. Blood glucose meters and strips 3. Urine testing strips 4. Syringes
Education	No
Services	Yes	Outpatient self-management training.

Copayments/deductibles

Does not specify.

Special features and issues

Delaware requires coverage of supplies only when the contract or insurance policy provides prescription drug coverage.

Statute Web Link:

http://delcode.delaware.gov/sessionlaws/ga140/chp376.shtml

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

Delaware Diabetes Prevention and Control Program, Delaware Health and Social Services.
http://www.dhss.delaware.gov/dph/dpc/diabetes.html

Florida	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
18,251,243	9000	161,000	458,000	264,000	225,000	1,121,000	14,426,000

State laws and regulations

Florida Statutes: FL ST §627.6408: Diabetes Treatment Services; FL ST §627.65745: Group, Blanket and Franchise.
Health Insurance Policies; FL ST §641.31: Health Maintenance Contracts.
Date enacted: 1995

Insurance policies required to provide coverage

A health insurance policy or group, blanket and franchise health insurance policy, and each health maintenance organization and prepaid health plan.

People covered by insurance mandate; Exceptions

Patients with diabetes; type of diabetes not specified.

Benefits required

Medication	n/a	Not mentioned.
Equipment	Yes	Insulin pumps covered if a qualified doctor deems medically necessary.
Supplies	Yes	Not specified.
Education	Yes	Not specified, but does not include medical nutritional therapy.
Services	Yes	Outpatient self-management training.

Copayments/deductibles

Does not specify.

Statute Web Link:

http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0627/SEC6408.HTM &Title=-%3e2007-%3eCh0627-%3eSection%206408

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Disease Management/Patient Education Program includes diabetes.
Program administrator: Pfizer Health Solutions
State has a mail order pharmacy benefit under its diabetes demonstration waiver.

Diabetes Prevention & Control Programs

Florida Diabetes Prevention and Control Program, Florida Department of Health.
http://www.floridadiabetes.org/

Georgia	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
9,544,750	5,600	114,000	222,000	100,000	71,000	516,600	7,831,000

State laws and regulations

§33-24-59.2 Effective date: July 1, 2002

Insurance policies required to provide coverage

Every individual major medical and group health insurance policy, group health insurance plan or policy, and any other form of managed or capitated care plans or policies is subject to statute.

People covered by insurance mandate; Exceptions

-Insulin-dependent diabetes
-Insulin-using diabetes
-Gestational diabetes
-Non-insulin-using diabetes

Benefits required

Medication	Yes	Pharmacologic agents.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Medical nutrition therapy included.
Services	Yes	Outpatient self-management training.

Copayments/deductibles

Subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy.

Statute Web Link:

http://www.legis.state.ga.us/legis/2003_04/gacode/33-24-59.2.html

Medicaid⁵

CHIP

Disease Management/Patient Education Program includes diabetes under the Georgia Enhanced Care Program.
Program administrator: Georgia Medicaid

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered*	Covered*	Covered*	Covered*
Covered	Covered	Covered	Covered

*Covered with Restrictions: Novo Nordisk, Lantus and Levemir insulins and disposable needles and syringe combinations used for insulin administration are preferred; certain quantity and age restrictions may apply.

Diabetes Prevention & Control Programs

Georgia Diabetes Prevention and Control, Georgia Department of Human Resources - Division of Public Health.
http://health.state.ga.us/programs/cardio/diabetes.asp

Hawaii	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes⁶	Number of People covered by Health Insurance⁴
1,283,388	600	10,000	33,000	16,000	13,000	72,600	1,172,000

State laws and regulations

Hawaii Statutes: HI ST §431:10A-121: Coverage for Diabetes; HI ST §432:1-612: Group Health Contracts.

Insurance policies required to provide coverage

Each policy of accident and health or sickness insurance that provides coverage for health care, other than an accident only, specified disease, hospital indemnity, Medicare supplement, long-term care, or other limited benefit health insurance policy, that is issued or renewed in this state, shall provide coverage.

People covered by insurance mandate; Exceptions

Patients with diabetes; type of diabetes not specified.

Benefits required

Medication	n/a	Not mentioned.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Not specified, but medical nutritional therapy is not covered.
Services	Yes	Self-management training.

Copayments/deductibles

Does not specify.

Statute Web Link:

http://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435E/HRS0431/HRS_0431-0010A-0121.htm

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered**	Covered**	Covered**
Covered	Covered	Covered	Covered

**Covered as durable medical equipment

Diabetes Prevention & Control Programs

Hawaii Diabetes Prevention and Control Program, Hawaii Department of Health.
http://hawaii.gov/health/family-child-health/chronic-disease/diabetes/index.html

Idaho	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
1,499,402	900	10,000	29,000	15,000	11,000	66,900	1,292,000

State laws and regulations

No applicable statute. Idaho is one of four states that does not have a mandate or insurance requirement specific to diabetes coverage.

Benefits required

Medication	No
Equipment	No
Supplies	No
Education	No
Services	No

Medicaid⁵

CHIP

Disease Management/Patient Education Program includes diabetes under the program Pay for Performance Disease Management.
Program administrator: Paul Leary, Medicaid Deputy Administrator

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered**	Covered**	Covered**
Covered	Covered	Covered	Covered

**Covered as durable medical equipment

Diabetes Prevention & Control Programs

Idaho Diabetes Control and Prevention Program Coordinator, Idaho Department of Health and Welfare.
http://www.healthandwelfare.idaho.gov/site/3396/default.aspx

Illinois	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
12,852,548	7,100	91,000	319,000	143,000	107,000	667,100	10,988,000

State laws and regulations

215 ILCS 5/365w - (H. 3427): Diabetes Coverage. Date enacted: 1998

Insurance policies required to provide coverage

A group policy of accident and health insurance that is amended, delivered, issued or renewed after the effective date of this amendatory act of 1998 shall provide coverage.

People covered by insurance mandate; Exceptions

-Type 1 diabetes
-Type 2 diabetes
-Gestational diabetes mellitus

Benefits required

Medication	Yes	Oral medications (to manage blood sugar).
Equipment	Yes	1. Blood glucose monitors 2. Cartridges 3. Lancets and lancing devices
Supplies	Yes	1. Insulin 2. Syringes 3. Pen needles 4. Test strips 5. Glucagon kits
Education	Yes	Medical nutritional therapy included.
Services	Yes	Outpatient self-management training.

Copayments/deductibles

Coverage under this subsection for diabetes self-management training shall be subject to the same deductible, copayment, and coinsurance provisions that apply to coverage under the policy for other services provided by the same type of provider.

Special features and issues

The equipment will be covered only if the insurance policy offers durable medical equipment benefits coverage.

Statute Web Link:

http://www.ilga.gov/legislation/ilcs/documents/021500050K356w.htm

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered*	Covered	Covered	Covered*
Covered*	Covered	Covered	Covered

*Covered with restrictions: Preferred drug list applies.

Diabetes Prevention & Control Programs

Diabetes Prevention & Control Program (DPCP), Illinois Department of Human Services.
http://www.dhs.state.il.us/page.aspx?item=33873

Indiana	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
6,345,289	3,500	59,000	161,000	91,000	58,000	376,500	5,546,000

State laws and regulations

Indiana Statutes: IN ST 27-8-14.5-1: "Health insurance plan" defined; IN ST 27-8-14.5-2: "Insured" defined; IN ST 27-8-14.5-3: "Insurer" defined; IN ST 27-8-14.5-4: Coverage for treatments, supplies, and equipment; IN ST 27-8- 14.5-5: Deductible, copayment, and coinsurance provisions; IN ST 27-8-14.5-6: Coverage for diabetes self-management training; IN ST 27-8-14.5-7: Adoption of rules.
Date enacted: 1997

Insurance policies required to provide coverage

“Insurer” means any person who provides health insurance and issues health insurance plans in Indiana. The term includes the following:
1. A licensed insurance company.
2. A prepaid hospital or medical service plan.
3. A health maintenance organization.
4. A state employee health benefit plan.
5. The state Medicaid plan.
6. Any person providing a plan of health insurance subject to state insurance law.

People covered by insurance mandate; Exceptions

Any individual, covered by a health insurance plan issued by an insurer, who has:
-Insulin-using diabetes;
-Non-insulin using diabetes; or
-Elevated blood glucose levels induced by pregnancy or another medical condition

Benefits required

Medication	Yes	Not specified.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Not specified.
Services	Yes	Self-management training: One or more visits after receiving a diagnosis of diabetes, one or more visits for reeducation or refresher training.
Coverage for Amputees	Yes	See below under "Special features and issues" for more detailed information.

Copayments/deductibles

An insured may not be required to pay an annual deductible or copayment that is greater than an annual deductible or copayment established for similar benefits under the health insurance plan. If the plan does not cover a similar benefit, the copayment or deductible may not be set at a level that materially diminishes the value of the diabetes benefit required by this chapter. An insured may be subject to coinsurance that is not greater than coinsurance established for similar benefits under the health insurance plan. If the plan does not cover a similar benefit, the coinsurance may not be set at a level that materially diminishes the value of the diabetes benefit required by this chapter.

Special features and issues

Coverage for Amputees: IC 27-8-24.2: A policy of accident and sickness insurance must provide coverage for orthotic devices and prosthetic devices, including repairs or replacements.

Statute Web Link:

http://www.in.gov/legislative/ic/code/title27/ar8/ch14.5.html

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered*	Covered*	Covered*	Covered*

* Some yearly limits may apply.

Diabetes Prevention & Control Programs

Indiana Diabetes Prevention and Control Program, Indiana State Department of Health.
http://www.in.gov/isdh/19701.htm

Iowa	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
2,988,046	1,600	19,000	62,000	30,000	38,000	151,600	2,695,000

State laws and regulations

IA ST §514C.18
Date enacted: 1999

Insurance policies required to provide coverage

Policies or contracts providing for third-party payment or prepayment of health or medical expenses. This section applies to the following classes of third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after July 1, 1999.

People covered by insurance mandate

Patients with diabetes; all types of diabetes mellitus.

Benefits required

Medication	No
Equipment and supplies	Yes	Blood glucose, meter and glucose strips for home monitoring.
Education	Yes	Not specified.
Services	Yes	Self-management training.

Copayments/deductibles

Does not specify.

Statute Web Link:

http://www.legis.state.ia.us/GA/78GA/Legislation/S/03000/S03022/Current.html

Medicaid⁵

CHIP

Disease Management/Patient Education program includes diabetes under IME Care Management.
Program administrator: Iowa Medicaid Enterprise.

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

Iowa Diabetes Prevention and Control Program, Iowa Department of Public Health.
http://www.idph.state.ia.us/hpcdp/diabetes.asp

Kansas	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
2,775,997	1,600	24,000	56,000	29,000	27,000	137,600	2,376,000

State laws and regulations

KS ST § 40-2,163
Date enacted: July 1, 1998

Insurance policies required to provide coverage

Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization that provides coverage for accident and health services and that is delivered, issued for delivery, amended or renewed on or after Jan 1, 1999.

People covered by insurance mandate

-Insulin dependent diabetes
-Insulin-using diabetes
-Gestational diabetes
-Non-insulin-using diabetes

Benefits required

Medication	Yes	Insulin.
Equipment and supplies	Yes	Hypodermic needles.
Education	Yes	Medical nutritional therapy included.
Services	Yes	Outpatient self-management training.

Copayments/deductibles

The benefits provided in this act shall be subject to the same annual deductible or coinsurance and the same requirement of medical necessity established for all other covered benefits within a given policy.

Statute Web Link:

http://www.kslegislature.org/legsrv-statutes/getStatuteFile.do?number=/40-2,163.html

Medicaid⁵

CHIP

The provisions of this act shall not apply to any Medicare supplement policy of insurance, as defined by the commissioner of insurance by rule and regulation or any policy of long-term care insurance.

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered***	Covered***	Covered**
Covered	Covered	Information not available.	Covered

**Covered as durable medical equipment
***Need prior authorization and covered as durable medical equipment

Diabetes Prevention & Control Programs

Kansas Diabetes Prevention and Control Program, Kansas Department of Health and Environment.
http://www.kdheks.gov/diabetes/index.htm

Kentucky	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
4,241,474	2,200	46,000	125,000	51,000	38,000	263,200	3,637,000

State laws and regulations

KY ST §304.17A-148: Coverage for diabetes; KY ST §304.17A-096: Basic health benefit plans permitted for individual, small group and association markets; Required coverage; Exclusions from coverage.
Date enacted: 1998

Insurance policies required to provide coverage

All health benefit plans issued or renewed on or after July 15, 1998, shall provide coverage. Insurers in the individual, small group or employer-organized association markets that offer a basic health benefit plan.

People covered by insurance mandate

-Insulin-dependent diabetes
-Insulin-using diabetes
-Gestational diabetes
-Non-insulin-using diabetes

Benefits required

Medication	Yes	All medications necessary to treat diabetes, if prescribed by a health care provider legally authorized to prescribe the items.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Medical nutritional therapy included.
Services	Yes	Outpatient self-management training.

Copayments/deductibles

The benefits provided in this section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given health benefit plan.

Statute Web Link:

http://www.lrc.ky.gov/krs/304-17a/148.pdf

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Not covered	Covered	Not covered
Covered	Not covered	Covered	Not covered

Diabetes Prevention & Control Programs

Kentucky Diabetes Prevention and Control Program, Kentucky Cabinet for Health and Family Services.
http://chfs.ky.gov/dph/ach/cd/diabetes.htm

Louisiana	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
4,293,204	2,400	41,000	132,000	60,000	35,000	271,400	3,421,000

State laws and regulations

LA R.S. 22:215.21
Date enacted: 1997

Insurance policies required to provide coverage

Any hospital, health, or medical expense insurance policy, hospital or medical service contract, health and accident insurance policy, or any other contract of this type providing comprehensive major medical benefits, including a group insurance plan, or any policy of family group, blanket, or association health and accident insurance, a self-insurance plan, an employee welfare benefit plan, or a health maintenance organization subscriber agreement that is issued or renewed in this state on or after Jan 1, 1998, or the Office of Group Benefits programs shall provide coverage.

People covered by insurance mandate

-Insulin-dependent diabetes
-Insulin-using diabetes
-Gestational diabetes
-Non-insulin using diabetes

Benefits required

Medication	n/a	Not mentioned.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Medical nutritional therapy included.
Services	Yes	One-time evaluation and training program per policy for diabetes self-management when medically necessary as determined by a physician.

Copayments/deductibles

The benefits provided in this section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy.

Special features and issues

The provisions of the section shall not apply to individually underwritten, guaranteed renewable or renewable limited benefit supplemental health insurance policies authorized to be issued in this state. LA legislation requires an insurer to cover prosthetic devices under its policy, as it would any other medical procedure. This was enacted in 2008.

Statute Web Link:

http://www.legis.state.la.us/lss/lss.asp?doc=82761

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

Louisiana Diabetes Program, Louisiana Department of Health and Hospitals.
http://www.dhh.louisiana.gov/offices/?ID=247

Maine	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
1,317,207	600	13,000	34,000	16,000	14,000	77,600	1,197,000

State laws and regulations

ME ST T. 24 §2332-F: Individual and group nonprofit hospital and medical services plan policies; ME ST T. 24-A §2754: Individual health policies and contracts; ME ST T. 24-A §2847-E: Group and blanket health insurance; ME ST T. 24-A §4240: Health maintenance organizations. Date enacted: 1996

Insurance policies required to provide coverage

All individual and group nonprofit hospital and medical services plan policies, contracts and certificates and all nonprofit health care plan policies, contracts and certificates; all individual health policies and contracts, except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts, must provide coverage for the medically appropriate and necessary equipment used to treat diabetes.

People covered by insurance mandate

Patients with diabetes; type of diabetes not specified.

Benefits required

Medication	Yes	Insulin.
Equipment	Yes	Not specified.
Supplies	Yes	1. Oral hypoglycemic agents 2. Blood glucose monitors 3. Test strips, lancets and syringes
Education	Yes	Not specified.
Services	Yes	The Ambulatory Diabetes Education and Follow-Up Diabetes Self-Management Training Program authorized by the state’s Diabetes Prevention and Control Program within the Department of Health and Human Service's Maine Centers for Disease Control and Prevention.
Coverage for Amputees	Yes	See below under "Special features and issues" for more detailed information.

Copayments/deductibles

Does not specify.

Special features and issues

Coverage for amputees: 22 §3174-FF. MaineCare Basic

Statute Web Link:

http://janus.state.me.us/legis/statutes/24-A/title24-Asec2754.html

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

Maine Diabetes Prevention and Control Program, Maine Department of Health & Human Services.
http://www.maine.gov/dhhs/bohdcfh/dcp/

Maryland	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
5,618,344	3,000	54,000	128,000	70,000	45,000	302,000	4,804,000

State laws and regulations

MD INSURANCE §15-706: Dietitians and nutritionists; MD INSURANCE §15-822: Coverage for diabetes equipment, supplies and self-management training. Date enacted: 1997

Insurance policies required to provide coverage

Insurers and nonprofit health service plans that provide hospital, medical or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies that are issued or delivered in the State; and health maintenance organizations that provide hospital, medical or surgical benefits to individuals or groups under contracts that are issued or delivered in the state.

People covered by insurance mandate

-Insulin-using diabetes
-Non-insulin-dependent diabetes
-Elevated blood glucose levels induced by pregnancy

Benefits required

Medication	n/a	Not mentioned.
Equipment	Yes	Not specified.
Supplies	Yes	Not specified.
Education	Yes	Medical nutrition therapy included.
Services	Yes	Outpatient self-management training.

Copayments/deductibles

The coverage required under this section may be subject to the annual deductibles or coinsurance requirements imposed by an entity subject to this section for similar coverage under the same health insurance policy or contract.

Special Features and Issues

MD (§15-820) requires an insurer to cover prosthetic devices under its policy, as it would any other medical procedure. Enacted in 1997.

Statute Web Link:

http://www.michie.com/maryland/lpext.dll/mdcode/165dd/176f0/17903/1791d?f=templates&fn=document-frame.htm&q=Diabetes&x=Advanced&2.0#LPHit1

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered**
Covered	Covered	Covered	Covered

**Covered as durable medical equipment

Diabetes Prevention & Control Programs

Maryland Diabetes Prevention and Control, Maryland Department of Health and Mental Hygiene
http://www.fha.state.md.us/cdp/diabetes.cfm

Massachusetts	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
6,449,755	4,800	48,000	129,000	63,000	54,000	302,800	6,000,000

State laws and regulations

MA ST 32A §17G: Group Insurance Commission coverage; MA ST 118E §10C: Required coverage for items medically necessary for diagnosis or treatment of diabetes; MA ST 175 §47N: Corporations; MA ST 176A §8P: Nonprofit Hospital Service Corporations; MA ST 176B §4S: Medical Service Corporations; MA ST 176G §4H: Health Maintenance Organizations. Date enacted: 2000

Insurance policies required to provide coverage

Contributory group general or blanket insurance for those in the service of the Commonwealth. An individual policy of accident and sickness insurance issued pursuant to section 108 that provides hospital expense and surgical expense insurance. Any group blanket policy of accident and sickness insurance issued pursuant to section 110 that provides hospital expense and surgical expense insurance. A contract between a subscriber and the corporation under an individual or group hospital service plan that provides hospital expense and surgical expense insurance. A subscription certificate under an individual or group medical service agreement that provides hospital expense and surgical expense insurance. Any individual or group health maintenance contract.

People covered by insurance mandate

-Insulin-dependent diabetes
-Insulin-using diabetes
-Gestational diabetes
-Non-insulin-dependent diabetes

Benefits required

Medication	Yes	1. Insulin 2. Prescribed oral diabetes medications that influence blood sugar levels
Equipment and supplies	Yes	1. Blood glucose monitors 2. Blood glucose monitoring strips for home use 3. Voice-synthesizers for blood glucose monitors for use by the legally blind 4. Visual magnifying aids for use by the legally blind 5. Urine glucose strips; ketone strips 6. Lancets 7. Insulin syringes 8. Laboratory tests, including glycosylated hemoglobin, or HbAlc, tests 9. Urinary protein/microalbumin and lipid profiles 10. Insulin pumps and insulin pump supplies 11. Insulin pens 12. Therapeutic/molded shoes and shoe inserts for people who have severe diabetic foot disease
Education	Yes	Medical nutritional therapy included, when provided by a certified diabetes health care provider participating with the health maintenance contract or affiliated with a provider participating with the health maintenance contract.
Services	Yes	Outpatient self-management training, when provided by a certified diabetes health care provider participating with the health maintenance contract or affiliated with a provider participating with the health maintenance contract.
Coverage for Amputees	Yes	See below under "Special features and issues" for more detailed information.

Copayments/deductibles

Does not specify.

Special features and issues

Coverage for Amputees: Chapter 176A: Section 8AA: Coverage of prosthetic devices and repairs

Statute Web Link:

http://www.mass.gov/legis/laws/mgl/32a-17g.htm

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

Massachusetts Diabetes Prevention and Control Program, Massachusetts Department of Health and Human Services
http://www.mass.gov/?pageID=eohhs2homepage&L=1&L0=Home&sid=Eeohhs2 (search 'diabetes')

Michigan	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
10,071,822	5,500	96,000	279,000	114,000	107,000	604,500	8,776,000

State laws and regulations

MI ST 500.3406p: Establishment of program to prevent onset of clinical diabetes required; report; coverage; “diabetes” defined; MI ST 550.1416b: Health Care Corporation. Date enacted: 2000

Insurance policies required to provide coverage

A health care corporation certificate shall provide benefits in each group and nongroup certificate for medically necessary medications prescribed by an allopathic, osteopathic or podiatric physician and used to treat foot ailments, infections and other medical conditions of the foot, ankle or nails associated with diabetes. An insurer providing an expense-incurred hospital, medical or surgical policy or certificate delivered or issued for delivery in this state and a health maintenance organization shall establish and provide to insureds, enrollees and participating providers a program to prevent the onset of clinical diabetes. This program for participating providers shall emphasize best practice guidelines to prevent the onset of clinical diabetes and to treat diabetes, including, but not limited to, diet, lifestyle, physical exercise and fitness, and early diagnosis and treatment.

People covered by insurance mandate

-Gestational diabetes
-Insulin-dependent diabetes
-Non-insulin-dependent diabetes

Benefits required

Medication	Yes	1. Insulin, if prescribed by an allopathic or osteopathic physician. 2. Nonexperimental medication for controlling blood sugar, if prescribed by an allopathic or osteopathic physician. 3. Medications used to treat of foot ailments, infections and other medical conditions of the foot, ankle or nails associated with diabetes, if prescribed by an allopathic, osteopathic or podiatric physician.
Equipment and supplies	Yes	1. Blood glucose monitors and blood glucose monitors for the legally blind 2. Test strips for glucose monitors 3. Visual reading and urine testing strips 4. Lancets and spring-powered lancet devices 5. Syringes 6. Insulin pumps and medical supplies required for the use of an insulin pump
Education	Yes	Not specified.
Services	Yes	Diabetes self-management training.

Copayments/deductibles

Does not specify.

Special Features and Issues

MI (MI Sec 550.1415) requires an insurer to cover prosthetic devices under its policy, as it would any other medical procedure. Enacted in 1986.

Statute Web Link:

http://www.legislature.mi.gov/(S(w3htol45kaxvgxfpbbi1sljj))/mileg.aspx?page=getObject&objectName=mcl-500-3406p

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered**	Covered**
Covered	Covered	Covered	Covered

**Covered as durable medical equipment

Diabetes Prevention & Control Programs

Michigan Diabetes Prevention & Management, Michigan Department of Community Health
http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_2980---,00.html

Minnesota	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
5,197,621	2,800	32,000	86,000	43,000	47,000	210,800	4,758,000

State laws and regulations

MN ST §62A.3093: Coverage for diabetes; MN ST §62A.316: Basic medicare supplement plan; coverage.
Date enacted: 1997

Insurance policies required to provide coverage

A health plan, including a plan providing the coverage specified in section 62A.011, subdivision 3, clause1 (10) (defining a “health plan” as a policy or certificate of accident and sickness insurance offered by an insurance company licensed under chapter 60A).

People covered by insurance mandate

-Type I diabetes
-Type II diabetes
-Gestational diabetes

Benefits required

Medication	Yes	Not specified.
Equipment	Yes	All physician-prescribed medically appropriate and necessary equipment and supplies used to manage and treat diabetes.
Supplies	Yes	All physician-prescribed medically appropriate and necessary equipment and supplies used to manage and treat diabetes.
Education	Yes	Medical nutrition therapy included.
Services	Yes	Diabetes outpatient self-management training.

Copayments/deductibles

Coverage required under this section is subject to the same deductible or coinsurance provisions applicable to the plan’s hospital, medical expense, medical equipment, or prescription drug benefits. A health carrier may not reduce or eliminate coverage due to this requirement.

Statute Web Link:

https://www.revisor.leg.state.mn.us/bin/getpub.php?pubtype=STAT_CHAP&year=2007&section=62A#stat.62A.3093.0;

Medicare Part D

Medicaid⁵

CHIP

A health plan providing the coverage specified in MN section 62A.011, subdivision 3, clause (10), is not subject to the requirements of subdivision 1, clause (1), with respect to equipment and supplies covered under the Medicare Part D Prescription Drug program, whether or not the covered person is enrolled in a Medicare Part D plan. This exception does not apply to a health plan providing the coverage specified in section 62A.011, subdivision 3, clause (10), that was in effect on Dec 31, 2005, if the covered person remains enrolled in the plan and does not enroll in a Medicare Part D plan. The basic Medicare supplement plan must have a level of coverage that will provide 80 percent of coverage for all physician-prescribed medically appropriate and necessary equipment and supplies used in the management and treatment of diabetes not otherwise covered under Part D of the Medicare program.

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered**	Covered**	Covered**
Covered	Covered	Limited Coverage	Covered

**Covered as durable medical equipment

Diabetes Prevention & Control Programs

Minnesota Diabetes Program, Minnesota Department of Health.
http://www.health.state.mn.us/diabetes/

Mississippi	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
2,918,785	1,700	41,000	90,000	45,000	29,000	207,700	2,358,000

State laws and regulations

MS ST § 83-9-46
Date enacted: 1998

Insurance policies required to provide coverage

Mississippi is one of three states that require health insurers to offer at least one type of policy that includes coverage of diabetes treatment, but does not require such coverage as a mandated benefit. The law states:
"Except as otherwise provided herein, from and after Jan 1, 1999, all individual and group health insurance policies or plans, pooled risk policies and all other forms of managed/capitated care plans or policies regulated by the State of Mississippi shall offer coverage for diabetes treatments."

People covered by insurance mandate; Exceptions

All forms of diabetes, regardless of mode of treatment if such treatment is prescribed by a health care professional legally authorized to prescribe such treatment and regardless of the age of onset or duration of the disease.

Benefits required

Medication	n/a	Not mentioned.
Equipment	Yes	Equipment and supplies used in connection with monitoring blood glucose and insulin administration and self-management training/education and medical nutrition therapy in an outpatient, inpatient or home health setting.
Supplies	Yes	Equipment and supplies used in connection with monitoring blood glucose and insulin administration and self-management training/education and medical nutrition therapy in an outpatient, inpatient or home health setting.
Education	Yes	Medical nutritional therapy included.
Services	Yes	Self-management training.

Copayments/deductibles

The benefits provided in this section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy.

Special features and issues

The coverage shall be offered on an optional basis, and each primary insured must accept or reject such coverage in writing and accept responsibility for premium payment.

Statute Web Link:

http://www.michie.com/mississippi/lpExt.dll/mscode/1c1b4/1c6bf/1c73a/1c759?f=templates&fn=document-frame.htm&2.0

Medicaid⁵

CHIP

Pays pharmacies $20 for average 30-minute encounter for disease management services for specified disorders, including diabetes.

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Not covered	Not covered	Not covered
Limited Coverage	Limited Coverage	Limited Coverage	Limited Coverage

Diabetes Prevention & Control Programs

Mississippi Diabetes Prevention & Control Program, Mississippi State Department of Health
http://www.msdh.state.ms.us/msdhsite/_static/43,0,296.html

Missouri	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
5,878,415	3,200	56,000	145,000	70,000	54,000	328,200	5,062,000

State laws and regulations

MO ST 376.385
Date enacted: 1997

Insurance policies required to provide coverage

Missouri is one of three states that require health insurers to offer at least one type of policy that includes coverage of diabetes treatment, but does not require such coverage as a mandated benefit. The law states:

"Each entity that offers individual and group health insurance policies that provide coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a health services corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements, to the extent not preempted by federal law, and all managed health care delivery entities of any type or description, that are delivered, issued for delivery, continued or renewed in this state on or after Jan 1, 1998, shall offer coverage."

People covered by insurance mandate

-Type I diabetes
-Type II diabetes
-Gestational diabetes

Benefits required

Medication	n/a	Not mentioned.
Equipment	Yes	Coverage for all physician-prescribed medically appropriate and necessary equipment, supplies and self-management training used to manage and treat diabetes.
Supplies	Yes	Coverage for all physician-prescribed medically appropriate and necessary equipment, supplies and self-management training used to manage and treat diabetes.
Education	Yes	Not specified.
Services	Yes	Self-management training.

Copayments/deductibles

No greater than any other health care service provided by the policy.

Statute Web Link:

Web link not available for statute.

Medicaid⁵

CHIP

Payment for cognitive services is provided to qualified pharmacies that enroll to provide specified services, including diabetes. Disease Management/Patient Education Program includes diabetes.
Program administrator: State of Missouri.

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
n/a	n/a	n/a	n/a

Diabetes Prevention & Control Programs

Missouri Diabetes Prevention and Control Program, Missouri Department of Health and Senior Services.
http://www.dhss.mo.gov/diabetes/

Montana	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
957,861	500	6,000	18,000	9,000	8,000	41,500	793,000

State laws and regulations

MT ST 2-18-704: Mandatory provisions; MT ST 33-22-129: Coverage for outpatient self-management training and education for treatment of diabetes; limited benefit for medically necessary equipment and supplies; MT ST 33-22-262: Limited coverage individual health benefit plan or managed care plan; demonstration project; Criteria; rulemaking; MT ST 33-22-1521: Association plan; minimum benefits; MT ST 33-31-102: Definitions.
Date enacted: 2001

Insurance policies required to provide coverage

Any group disability policy, certificate of insurance, or membership contract is required to provide coverage. Includes state employee group insurance program, university employee group insurance program, and any employee group insurance program of a city, town, or other political subdivision of the state if benefits from such insurance falls below the provisions of the statute.

People covered by insurance mandate

Patients with diabetes; type of diabetes not specified.

Benefits required

Medication	Yes	1. Insulin 2. One prescriptive oral agent for controlling blood sugar levels for each class of drug
Equipment and supplies	Yes	1. Syringes 2. Injection aids 3. Devices to self-monitor glucose levels (including those for the visually impaired) 4. Test strips 5. Visual reading and urine test strips 6. One insulin pump for each warranty period 7. Accessories to insulin pumps 8. Glucagon emergency kits
Education	Yes	Not specified.
Services	Yes	Outpatient self-management training

Copayments/deductibles

Annual copayment and deductible provisions are subject to the same terms and conditions that apply to all other covered benefits within a given policy.

Statute Web Link:

http://data.opi.mt.gov/bills/mca/2/18/2-18-704.htm

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered***	Covered**	Covered**	Covered**
Covered	Covered	Covered	Covered

**Covered as durable medical equipment
***Need prior authorization

Diabetes Prevention & Control Programs

Montana Diabetes Project, Montana Department of Public Health and Human Services.
http://www.dphhs.mt.gov/PHSD/Diabetes/diabetes-index.shtml

Nebraska	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
1,774,571	1,000	14,000	35,000	19,000	21,000	90,000	1,522,000

State laws and regulations

NE ST § 44-790
Date enacted: 1999

Insurance policies required to provide coverage

Any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage, and any self-funded employee benefit plan to the extent not preempted by federal law shall include coverage.

People covered by insurance mandate

-Insulin-dependent diabetes
-Insulin-using diabetes
-Gestational diabetes
-Non-insulin-using diabetes

Benefits required

Medication	Yes	Not specified.
Equipment and supplies	Yes	1. Blood glucose monitors 2. Blood glucose monitors for the legally blind 3. Test strips for glucose monitors 4. Urine testing strips 5. Insulin 6. Injection aids 7. Lancet and lancet devices 8. Syringes 9. Insulin pumps and all supplies for the pump 10. Insulin infusion devices 11. Oral agents for controlling blood sugars 12. Glucose agents and glucagon kits 13. Insulin measurement 14. Administration aids for the visually impaired 15. Patient management materials that provide essential diabetes self-management information 16. Podiatric appliances to prevent complications associated with diabetes.
Education	Yes	Medical nutritional therapy included.
Services	Yes	Diabetes self-management training and patient management.

Copayments/deductibles

Insurance mandate does not prevent application of a deductible, copayment or network incentives contained in the policy or outpatient care provisions that extend coverage primarily in relation to hospital confinement or surgery.

Statute Web Link:

http://uniweb.legislature.ne.gov/LegalDocs/view.php?page=s4407090000

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered***	Covered**	Covered**	Covered**
Covered***	Covered	Covered	Covered

**Covered as durable medical equipment
***Need prior authorization

Diabetes Prevention & Control Programs

Nebraska Diabetes Prevention & Control Program, Nebraska Department of Health & Human Services.
http://www.dhhs.ne.gov/dpc/ndcp.htm

Nevada	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
2,565,382	1,400	17,000	55,000	27,000	18,000	117,400	2,126,000

State laws and regulations

NV ST 689A.0427: Individual coverage; NV ST 689B.0357: Group; NV ST 695B.1927: Nonprofit corporations for hospital, medical and dental service; NV ST 695C.1727: Health maintenance organization.
Date enacted: 1997

Insurance policies required to provide coverage

Policy of health insurance, group policy of insurance, and contract for hospital or medical service that provides coverage for hospital, medical or surgical expenses, and health maintenance organizations.

People covered by insurance mandate

-Type I diabetes
-Type II diabetes
-Gestational diabetes

Benefits required

Medication	Yes	Not specified.
Equipment and supplies	Yes	Not specified.
Education	Yes	Not specified.
Services	Yes	“Coverage for the self-management of diabetes” includes: 1. Training and education provided to an insured person after he or she is initially diagnosed with diabetes that is medically necessary for the care and management of diabetes, including, without limitation, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes; 2. Training and education that is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the insured person and that requires modification of the program of self-management of diabetes. 3. Training and education that is medically necessary due to the development of new techniques and treatment for diabetes.

Copayments/deductibles

Insurers must provide the coverage required by this section subject to the same deductible, copayment, coinsurance and other such conditions.

Statute Web Link:

http://www.leg.state.nv.us/NRS/NRS-689A.html

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered	Covered	Covered	Covered

Diabetes Prevention & Control Programs

Nevada Diabetes Prevention & Control Program, Nevada Department of Health and Human Services.
http://health.nv.gov/index.php?option=com_content&task=view&id=180&Itemid=308

New Hampshire	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
1,315,828	700	10,000	27,000	15,000	12,000	65,700	1,177,000

State laws and regulations

NH ST §415:6-e: Individual policy; NH ST § 415:18-f: Contract of group or blanket accident; NH ST §420-A:17-a: Health service corporations; NH ST §420-B:8-k: Health maintenance organizations.
Date enacted: 1997

Insurance policies required to provide coverage

Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance that provides benefits for medical or hospital expenses shall provide to certificate holders of such insurance, who are residents of this state, coverage for medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner. Applies to individual policies from insurers, group or blanket policies from insurers, group or blanket policies from health service corporations, and group or blanket policies from health maintenance organizations.

People covered by insurance mandate

Patients with diabetes; type of diabetes not specified.

Benefits required

Medication	Yes	1. Medically appropriate or necessary insulin 2. Oral agents
Equipment and Supplies	Yes	Not specified.
Education	Yes	Medical nutritional therapy included.
Services	Yes	Not specified.
Coverage for Amputees	Yes	See below under "Special features and issues" for more detailed information.

Copayments/deductibles

Does not specify.

Special features and issues

Insurance companies are required to cover only medically appropriate or necessary diabetes equipment if they provide durable medical coverage. Insurers are required to cover insulin, oral medications to treat diabetes and equipment, but only if they offer a prescription drug rider. Coverage for Amputees: 415:18-n: Coverage for certain prosthetic devices

Statute Web Link:

http://www.gencourt.state.nh.us/rsa/html/xxxvii/415/415-6-e.htm

Medicaid⁵

CHIP

Prescribed Insulin	Disposable Needles	Syringe Combinations	Blood Glucose Strips
Covered	Covered	Covered	Covered
Covered*	Covered*	Covered*	Covered*

* Co-pay required.

Diabetes Prevention & Control Programs

New Hampshire Diabetes Education Program, New Hampshire Department of Health & Human Services.
http://www.dhhs.state.nh.us/DHHS/CDPC/dep.htm

New Jersey	Number of Residents with Diabetes by Age group
State Population¹	Age Birth to 19²	Age 18 to 44	Age 45 to 64	Age 65 to 74	Age 75+	Total State Population with Diabetes³	Number of People covered by Health Insurance⁴
8,685,920	4,600	67,000	206,000	111,000	87,000	479,600	7,208,000

State laws and regulations

NJ ST 17:48-6n: Individual, group hospital service corporation; NJ ST 17:48A-7l: Individual, group medical service corporation; NJ ST 17:48E-35.11: Individual group health service corporation; NJ ST 17B:26-2.1l: Individual health insurance policy; NJ ST 17B:27-46.1m: Group health insurance policy; NJ ST 26:2J-4.11: HMO contracts. Date enacted: 1995

Insurance policies required to provide coverage

Hospital service corporation contracts, medical service corporation contracts, health service corporation contracts, individual health insurance policies, group health insurance policies, and health care services contracts.

People covered by insurance mandate

Patients with diabetes; type of diabetes not specified.

Benefits required

Medication	Yes	1. Insulin 2. Oral agents for controlling blood sugar
Equipment and supplies	Yes	1. Blood glucose monitors and blood glucose monitors for the legally blind 2. Test strips for glucose monitors and visual reading and urine testing strips 3. Injection aids 4. Cartridges for the legally blind 5. Syringes 6. Insulin pumps and appurtenances thereto 7. Insulin infusion devices
Education	Yes	Not specified.
Services	Yes	Self-management training.
Coverage for Amputees	Yes	See below under "Special features and issues" for more detailed information.

Copayments/deductibles

Benefits shall be provided to the same extent as for any other sickness under the policy.

Special features and issues

Coverage for amputees: C.17:48-6ff: Hospital service corporation to provide benefits for orthotic and prosthetic appliances

Statute Web Link:

Providing Diabetes Health Coverage: State Laws & Programs

What this Report Covers

Some Diabetes Statistics

Obesity and Diabetes

Diabetes and Native Americans

State and Federal Requirements for Coverage

Coverage for Supplies and Equipment

Coverage for Artificial Limbs (Prosthetic Devices)

National Statistics on Diabetes

Prevalence of Diagnosed and Undiagnosed Diabetes in the United States, All Ages, 2007

Prevalence of Diagnosed and Undiagnosed Diabetes among People Aged 20 Years or Older, United States, 2007

Diabetes Management and Treatment Products

Supplies/Equipment

Examples of widely-used Brands and types

Insulin Syringes

Insulin

Insulin Pumps

Blood Glucose Test Meters and Test Strips

Examples of insulin pens and products

KEY/DEFINITION

TERM

DEFINITION

Blanket Health Insurance Policy

Normally, a health insurance policy that covers a group of individuals such as employees of an organization, students at a school, members or a labor union, etc.

Copayment

A fixed dollar amount that must be paid by an insured individual each time a medical service is accessed before the insurance company provides its share of the medical expenses.

Deductibles

A fixed dollar amount that must be paid by an insured patient, normally during an annual period, before the insurance company pays the cost of medical services.

Diabetes Education

Includes formal training on prevention and management of diabetes, with scheduled follow-up and screening.

Durable medical equipment

Term used to describe certain insurance related benefits such as wheelchairs, oxygen tent, hospital beds, etc. However, the term generally includes insulin pumps, insulin pump supplies, blood glucose meters, blood glucose meter test strips and other day-to-day diabetes management needs.

Gestational Diabetes

Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women - about 135,000 cases of gestational diabetes in the United States each year.

Glycemic control

Refers to the typical and changing levels of blood sugar in a person with diabetes.

Interdialytic parenteral nutrition

Nutrition provided to diabetes patients during dialysis.

Lancing and Lancet Devices

A blood-sampling device used by diabetics to draw blood from a fingertip or other area to monitor blood glucose levels.

Medical Nutrition Therapy

Nutritional diagnostic, therapeutic, and counseling services provided by a registered dietitian.

Medigap

Refers to the various private supplemental health insurance plans sold to Medicare beneficiaries that provide coverage for medical expenses not or only partially covered by federal Medicare.

National Diabetes Educational Program (NDEP)

NDEP is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with the support of more than 200 partner organizations. NDEP works to translate and spread the latest science on diabetes to the public.

Orthotic Insert or Orthotics

Refers to procedures dealing with the support and bracing of weak or ineffective joints and muscles. For people with diabetes this can include specially designed shoes aimed to reduce the risk of a lower leg amputation to more involved prosthetic devices.

Subscription Contracts

A contract between a corporation and its subscribers to provide certain medical services.

State Insurance and Medicaid Coverage Requirements and Programs

Number of Residents with Diabetes by Age group

State laws and regulations

Benefits required

Medicaid5

CHIP

Diabetes Prevention & Control Programs

Medicaid⁵