Preventing and Controlling Diabetes

Approximately 25.8 million Americans live with diabetes. This number more than doubled during the past two decades, and researchers expect diabetes to become more prevalent in coming years. Researchers attribute approximately 10 percent of all U.S. health care spending to diabetes. According to the Centers for Disease Control and Prevention (CDC), people with diagnosed diabetes, on average, have medical expenditures that are 2.3 times higher than people without the disease. Diabetes can also lead to painful and costly health complications, including nervous system damage, heart disease, stroke, blindness, and kidney disease.  To address the increasing burden of diabetes, and disparities in health care coverage for the condition, CDC funds state-based diabetes prevention and control programs in all states, the District of Columbia, and eight territories. Several of these programs encourage Medicaid reimbursement for patients’ education on the self-management of diabetes. This kind of education is intended to help people with diabetes lead healthier lives by better controlling their diabetes, preventing complications and reducing costs. New York and Texas have both recently expanded diabetes self-management education.   

In 2009, for example, legislators amended New York’s Social Services law to give the state’s nearly 300,000 Medicaid beneficiaries with diabetes the opportunity to learn how to self-manage the disease. After the law passed, New York’s diabetes program staff worked closely with the Office of Health Insurance Programs to publicize this benefit to New York’s Certified Diabetes Educators and to increase health care clinicians’ referrals for its use. Data from the first year of benefit use were analyzed to consider whether to extend the benefit to other practitioners. In January 2011, the state’s existing policy was expanded to allow additional accredited diabetes self-management education programs to obtain reimbursement for their services through Medicaid.

The Texas Diabetes Prevention and Control Program and the Texas Diabetes Council collaborated on changes to public policy to ensure that all people with diabetes have access to diabetes self-management education. The Texas diabetes program worked with statisticians at the Texas Health and Human Services Commission to collect data on Medicaid recipients with diabetes. Data collected by the program provided a resource for legislators who enacted legislation in 2009 to create a pilot program for about 2,000 people with diabetes that allows at least 10 hours of self-management education to be covered by Medicaid, with the option for follow-up education.

Under the pilot, participants have access to diabetes self-management education that meets state and national standards. The Texas diabetes program and partner organizations are monitoring the progress of the project, and information learned will shape future efforts to make the service available to all Medicaid recipients with diabetes in Texas. In addition, Texas legislation enacted in 2011 requires a report by Dec. 1, 2012, estimating the annual direct and indirect costs, both public and private, of preventing and treating diabetes in Texas; and an assessment every two years of state-administered diabetes programs including number of people served, areas where diabetes services are unavailable and number of diabetes treatment providers under state programs.

Diabetes Resource:
CDC 2011 National Diabetes Fact Sheet

Upcoming Events and NCSL Resources

Fall Forum, Nov. 30- Dec. 2, 2011, in Tampa, Fla. Come learn about key state issues, and help tackle difficult policy concerns such as budget gaps, health care coverage, education affordability, transportation funding, energy costs and many others.  NCSL's Standing Committees will also meet at Fall Forum to share state concerns and the effect of federal actions.  The Committees saved states billions of dollars over the years as they work to fight unfunded federal mandates.

NCSL produces a series of brief reports about a variety of topics contained in the federal health reform legislation, known as the Accountable Care Act of 2010(ACA). The briefs are intended to help legislators and legislative staff understand better various provisions of the ACA and to provide resources for additional information. 

Technical Assistance
NCSL can provide testimony to legislatures on chronic disease prevention; health promotion; preventing injuries and violence; reducing health disparities; access to health care; community health centers; and other health policy topics. Contact Alise Garcia at Health-info@ncsl.org.

NCSL Resources 
LegisBrief: State Approaches to Prevent and Control Diabetes
Diabetes Overview Page
Diabetes in Health Reform
Diabetes in State Budgets
Diabetes Health Coverage: State Laws and Programs
Diabetes - State Legislation Overview