Diabetes in State Budgets: A 50-State Survey for Fiscal Year 2011

May 2011

Diabetes in State Budgets: A 50-State Survey for Fiscal Year 2011  (PDF file - 8 pages)

For more information about state specific responses to diabetes, please visit our NCSL report: Providing Diabetes Health Coverage: State Laws & Programs.

Introduction

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. People with chronic diseases such as diabetes often have uncoordinated care, inadequate informa­tion and high health care costs. Diabetes costs in the United States grew swiftly between 2002 and 2007 to more than $174 billion. Of this amount, $116 billion was for direct treatment costs, and an estimated $58 billion was due to lost productivity. According to an American Diabetes Association report, “People with diagnosed diabetes, on average, have medical expenditures that are approximately 2.3 times higher than the expenditures would be in the absence of diabetes.” It also is estimated that approximately 10 percent all health care spending is attributed to diabetes.

Public health spending often is dwarfed by health-care expenditures, which averaged about $3,500 per capita in 2006, according to the Centers for Disease Control and Prevention (CDC). States, which play a significant role in public health and in funding public health activities, are responsible for monitoring and investigating emerging health issues, informing the public about health, enforcing state health laws, and preparing for and responding to disasters and health crises. To assume such a significant role in protect­ing the public health, states need both the support of the federal government and the necessary resources. States rely on funding from the Centers for Disease Control and Prevention to support efforts to prevent and treat diabetes. (For information about CDC grants to states for diabetes, see Table 1 below.)

State governments spend billions of dollars treating, educating and seeking to prevent diabetes. Most of these activities and expenditures are not identified or “earmarked”¹ for the disease and its costs. For FY 2011, the National Conference of State Legislatures conducted a first-ever, 50-state analysis of appropria­tions explicitly identified for diabetes.²

• Fifteen states—Delaware, Florida, Illinois, Louisiana, Michigan, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Pennsylvania, Tennessee, Texas, Virginia and West Virginia—ap­propriated a total of $39,864,721 specifically for diabetes treatment and prevention. Portions of these funds are allocated to chronic diseases.
• In addition, Kentucky, New York, South Carolina and Wisconsin passed budget provisions specifi­cally for diabetes that were vetoed by the governor.

In addition to budget appropriations, states passed other legislation.

•  Alabama, Connecticut, Delaware, Georgia and Tennessee enacted legislation for other programs related to diabetes. These provisions totaled $264,000 (where totals were available).
• In New Jersey, New York and Pennsylvania, similar bills were pending as of mid-November 2010.³

Observations

Most state budgets use a line-item format, appropriating funds for a one-year period to a specific state agency or office. In most states, these budgets do not attempt to specify treatment by medical condition or segregate prevention activities by disease.

State officials make numerous decisions regarding use of federal funds, including appropriating match­ing funds for federal allocations, but these are not always detailed in the annual legislative appropriation process.

Table 1. Funding for Diabetes

NOTES FOR TABLE: Florida, Louisiana, Massachusetts, Michigan, Nebraska, New Hampshire, Texas, and Wisconsin refer to diabetes prevention or treatment in the specific line items. However, the money may be a pass through of federal funds or may be allocated to a number of diseases or programs.

Budget Appropriations and Other Legsiation

All bill, act and chapter numbers refer to 2010 legislative sessions unless otherwise designated.

The list below includes all states, with notations about diabetes funding. It includes source citations for all state budgets including those that did not include such funding.

Alabama | Alaska | Arizona | Arkansas | California | Colorado |  Connecticut | Washington, D.C. | Delaware | Florida | Georgia | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky | Louisiana | Maine | Maryland | Massachusetts | Michigan | Minnesota | Mississippi |  Missouri | Montana | Nebraska | Nevada | New Hampshire | New Jersey | New Mexico | New York | North Carolina | North Dakota | Ohio | Oklahoma | Oregon | Pennsylvania | Rhode Island | South Carolina | South Dakota | Tennessee | Texas | Utah | Vermont | Virginia | Washington |  West Virginia | Wisconsin | Wyoming

Alabama
Budget:  Alabama’s state budget does not appropriate money specifically for diabetes treatment or prevention. Act No. 2010-553 (AL H 290, AL S 303)

Other:  A separate act makes an appropriation by reallocating $250,000 from Operations and Maintenance and Program Support to the University of Alabama at Birmingham to Children's Hospital for the Diabetes Research Program. The state fiscal year begins October 1. Act No. 2010-610 (AL H 274, AL S 243)

Alaska
Budget: Alaska’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 41 (AK H 300)

Arizona
Budget: Arizona’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 10 (AZ S 2010 b)

Arkansas
Budget: Arkansas’ state budget does not appropriate money specifically for diabetes treatment or prevention. Act No. 239 (AR S 65)

California
Budget: California’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 712(CA SB 870)

Colorado
Budget: Colorado’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 453 (CO H 1376)

Connecticut
Budget: Connecticut’s state budget does not appropriate money specifically for diabetes treatment or prevention. Public Act No. 10-179 (CT S 494)

Other: A separate act concerns the Biomedical Research Trust Fund, which accepts transfers from the Tobacco Settlement Fund. The Biomedical Research Trust Fund can also apply for and accept gifts, grants or donations from public or private sources to carry out its objectives. The Commissioner of Public Health may allocate grants-in-aid from the trust fund to eligible institutions for funding diabetes biomedical research. Public Act No. 10-136 (CT S 354)

Delaware
Budget: The budget allocates $450.00 from $48,731.50 Appropriated Special Funds received because of the Master Settlement Agreement on tobacco funds. The funds will go to the Department of Health and Social Services, Community Health Division for Diabetes. Chapter Number 327 (DE S 310)

Other: A separate act appropriates grants-in-aid to the American Diabetes Association for $14,000. Chapter Number 328 (DE S 315 b)

District of Columbia
Budget: The District of Columbia’s state budget does not appropriate money specifically for diabetes treatment or prevention. (DC B 728)

Florida
Budget: Yes, the budget includes $400,018 in grants and aids to the Regional Diabetes Center at University of Miami. The act reduces the General Revenue Fund and Medical Care Trust Fund (by $634,423 GRF and $1,015,142 MCTF) because of implementing the manufacturer drug rebate collections on injectable drugs reimbursed through physician services claims. The state will negotiate mail order delivery services with pharmacies at no cost to patients who have chronic diseases—including diabetes. The intent is to assist Medicaid patients in receiving their prescriptions and to reduce program costs. The number of participants is limited to 20,000. According to the Supplemental Nutrition Assistance Program (SNAP) Nutrition Education federal grant specifications, money from the increased Federal Grant Trust Fund ($847,548 increase, $3,571,681 total) must fund program curricula that include general information on diabetes. Chapter No. 152 (FL H 5001)

Georgia
Budget: Georgia’s state budget does not appropriate money specifically for diabetes treatment or prevention.  Act No. 684 (GA H 948)

Other: A separate act creates a special license plate identifying people with diabetes. The state will deposit the funds raised by the sale of this special license plate in the general fund. Act No. 360 (GA H 1055)

Other: Another act creates the "Diabetes and Health Improvement Act of 2010" which establishes the Georgia Diabetes Control Grant Program and advisory committee. The committee will establish two grant programs to promote a statewide effort to combat the proliferation of diabetes. Specifically, the Georgia Diabetes Control Grant Program will administer two grants targeted at new, expanded, or innovative approaches to address diabetes. One program must provide grants to middle schools and high schools to promote the understanding and prevention of diabetes and the local board of education will allocate the grants. The other grant will provide money to health care providers for support of evidence-based diabetes programs for education, screening, disease management, and self-management targeting populations at greatest risk for pre-diabetes, diabetes, and the complications of diabetes. The committee may also award grants to address evidence-based activities that focus on policy, systems, and environmental changes that support prevention, early detection, and treatment of diabetes. Act No. 491 (GA S 435)

Hawaii
Budget: Hawaii’s state budget does not appropriate money specifically for diabetes treatment or prevention.  Act No. 180 (HI H 2200, HI S 2765)

Idaho
Budget: Idaho’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 269 (ID H 702)

Illinois
Budget: The budget appropriates $100,000 payable from the Diabetes Research Check-Off Fund for diabetes research. It also appropriates $1,000,000 payable from the Department of Human Services Federal Projects Fund for grants and administrative expenses associated with Diabetes Prevention and Control. Public Act No. 956 (IL H 859)

Indiana
Budget: Indiana’s state budget does not appropriate money specifically for diabetes treatment or prevention. House Enrolled Act No. 1001 (IN H 1001- 2009)

Iowa
Budget: Iowa’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 1193 (IA H 2531, IA S 2385)

Kansas
Budget: Kansas’ state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 2010-165 (KS S 572)

Kentucky
Budget: Kentucky’s budget act originally included changes to the Public Employee Health Coverage Program. The changes incorporated new insurance plan options and a Pilot Wellness Program. The voluntary program would have provided incentives to employees that focused on many chronic disease-related issues such as diabetes management. The governor vetoed this item in the bill. Act No. 1 (KY H 1 a)

Louisiana
Budget: The Louisiana state budget appropriated $181,545 of federal American Recovery and Reinvestment (ARRA) grants to implement the Stanford Chronic Disease Self-management Program and diabetes and arthritis workshops. The state will allocate money from the $904,744,434 payments to public providers’ line item to Medicaid providers that encourage enrollees to obtain preventive care including some diabetes measures. The Pennington Biomedical Research Center will receive $825,561 to continue its work on nutritional research and preventive medicine for chronic diseases such as diabetes. Act No. 11 (LA H 1)

Maine
Budget: Maine’s state budget does not appropriate money specifically for diabetes treatment or prevention. Public Law No. 213 (ME H 274)

Maryland
Budget: Maryland’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 482 (MD S 140, MD H 150)

Massachusetts
Budget:  Massachusetts’ budget appropriates $6,074,484 to the Department of Public Health for the promotion of health and disease prevention including, diabetes screening and outreach. Chapter 131 (MA H 4800)

A supplemental budget added that funds be expended for a program to address the needs of children under the age of 18 with Type 1 or Type 2 diabetes in underserved areas. Chapter 359

Michigan
Budget: Michigan’s state budget allocates $2,570,100 for 12.2 state diabetes and kidney program FTE. Additionally, the program receives $54,500 in order to establish and implement an early mental health services intervention pilot project. This project will provide care coordination, disease management, and pharmacy management to eligible recipients suffering from chronic disease, including diabetes. Participating organizations may make use of data sharing, joint information technology efforts, and financial incentives to health providers and recipients in this project.  The pilot project shall make use of pre-established objectives and outcome measures to determine the cost effectiveness of the project. Participating organizations shall collect data to study and monitor the correlation between early mental health treatment services to program participants and improvement in the management of their chronic disease. Funds may be allocated up to $25,000 for a diabetes management pilot project in Muskegon County and a portion of the funds may be allocated to the National Kidney Foundation of Michigan for kidney disease prevention programming including early identification and education programs and kidney disease prevention demonstration projects. The state fiscal year begins October 1. Public Act No. 187 (MI S 1152)

Minnesota
Budget: Minnesota’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 2010-1 (M H 1 a, M S 1 a)

Mississippi
Budget: Mississippi’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 562 (MS H 1059)

Missouri
Budget: Missouri’s state budget does not appropriate money specifically for diabetes treatment or prevention. (MO H 2010)- Signed by governor

Montana
Budget: Montana’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 488 (MT H 2- 2009)

Nebraska
Budget: Nebraska’s 2-year state budget for FY 2010-2011 appropriates $1,627,755 ($47,755 General Fund and $1,580,000 Cash Funds) to minority public health services in certain counties. The state will allocate portions of these funds to implement a minority health initiative, which may target diabetes. It also appropriates $1,442,315 ($42,315 GF and $1,400,000 CF) to federally qualified health centers in certain congressional districts. They will also use portions of these funds to implement minority health initiatives, which may focus on diabetes. (NE L 315)-Signed by the governor, 5/19/09

Nevada
Budget: Nevada’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 10 (NV A 6 b)

New Hampshire
Budget: New Hampshire’s state budget appropriates $322,683 in federal funds to the Division of Public Health for diabetes. In 2010, $326,032 was appropriated, also from federal funds. Chapter No. 143 (NH H 1)

New Jersey
Budget: New Jersey’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 35 (NJ S 3000, NJ A 3000)

Other: Other legislation establishes special license plates to fund juvenile diabetes research and education. (NJ S 939, NJ A 2182)- Pending; held in committee since 2/11/2010

New Mexico
Budget: The budget transfers $881,400 from the tobacco settlement program fund to diabetes prevention and control services. Chapter No. 2010-6 (NM H 2 a)

New York
Budget: New York’s budget allocates $100,000 to the Diabetes Research and Education Account. The bill also allocated $401,000 for additional services and expenses of an early diagnosis and control program for diabetes and $100,000 to the Juvenile Diabetes Research Foundation; however, the governor vetoed these line items. The state fiscal year begins April 1 each year. Chapter No. 54 (NY A 9704- 2009) 

North Carolina
Budget: The legislation establishes a special license plate to benefit the Juvenile Diabetes Research Foundation. Session Law Number 2010-31 (NC S 897)

North Dakota
Budget: North Dakota’s state budget does not appropriate money specifically for diabetes treatment or prevention. Budget No. 301 (ND S 2004, 2047, 2227, 2230, 2333, 2358, 2412, ND H 1231)

Ohio
Budget: Ohio’s state budget does not appropriate money specifically for diabetes treatment or prevention. Session Law No. 9 (OH H 1)

Oklahoma
Budget: Oklahoma’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 427 (OK S 1561)

Oregon
Budget: Oregon’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 95 (OR H 5100 a)

Pennsylvania
Budget: The Pennsylvania budget appropriates $190,000 for diabetes programs. Act No. 1A (PA H 2279)

Rhode Island
Budget: Rhode Island’s state budget does not appropriate money specifically for diabetes treatment or prevention. Public Law No. 2010-23 (RI H 7397)

South Carolina
Budget: The South Carolina budget appropriated $289,088 to the Medical University of South Carolina Diabetes Center. However, the governor vetoed this provision stating that the South Carolina Diabetes Prevention and Control Program receives federal funding, and MUSC should focus on instructing students to become health professionals. The governor also vetoed provisions within the budget to allocate money to Rural Hospitals for the enhancement of disease prevention activities—one of which was diabetes. Act No. 291 (SC H 4657)

South Dakota
Budget: South Dakota’s state budget does not appropriate money specifically for diabetes treatment or prevention. Session Law. Chapter No. 25 (SD S 196)

Tennessee
Budget: The Tennessee budget appropriates $143,000 to the Diabetes Prevention and Health Improvement Fund. Chapter No. 1108 (TN S 3919, TN H 3928)

Other: Separate legislation provides grants to schools through local education agencies for programs that promote the understanding and prevention of diabetes and provides grants to providers of primary and specialty health care services related to the treatment of pre-diabetes and diabetes. Chapter No. 187 (TN H 2270, TN S 2264)

Texas
Budget: Texas’ budget allows funds from the End Stage Renal Disease Prevention Program to be allocated to outreach to individuals with diabetes mellitus, hypertension, or with a family history of kidney disease, diabetes, or hypertension and to physicians to ensure appropriate treatment for individuals at risk for End Stage Renal Disease. It appropriates $3,000,000 in GF to the Texas Diabetes Council's Stark Model of Community-based Diabetes Prevention and Control. The money must be used to reduce the health and economic burdens of diabetes through expansion of the Texas Diabetes Council/Stark Diabetes Center model of community-based diabetes care and education. This initiative will utilize the Stark Diabetes Center to establish four regional centers. The budget also appropriates $1,000,000 during the biennium to fund a study conducted by Texas Tech University and the Kidney Chronic Disease task force. The study will address kidney disease and its precursors, including diabetes. Included in the study are public health policy hypotheses and conclusions. The Texas Education Agency shall grant $10,000,000 for fiscal year 2011 to school districts for the support of in-school physical education and fitness programs for students in grades six through eight. The criteria for the grant must further the goal of reducing Type II diabetes in school districts that have proportionately high numbers of economically disadvantaged students. The University of Texas- Pan America will receive $209,844 for their diabetes registry. The University of Texas Southwestern Medical Center at Dallas’ Center for Obesity, Diabetes and Metabolism will receive $9,000,000 for research. Finally, Texas Tech University Health Sciences Center’s Diabetes Research Center will receive $289,140. The state fiscal year begins September 1 for a 2-year cycle. (TX SB 1)- Signed by the governor, 6/19/2009

Utah
Budget: Utah’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 408 (UT H 2)

Vermont
Budget: Vermont’s state budget does not appropriate money specifically for diabetes treatment or prevention. Act No. 156 (VT H 789)

Virginia
Budget: The Virginia budget appropriates at least $156,397 in support of diabetes education and public service at the Virginia Center for Diabetes Professional Education at the University of Virginia. Acts of Assembly. Chapter No. 874 (VA H 30)

Washington
Budget: Washington’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 564 (WA H 1244, WA S 5600)

West Virginia
Budget: The budget appropriates $70,000 to the Diabetes Education Fund. Act No. 8 (WV S 213)

Wisconsin
Budget: Wisconsin’s budget appropriates $25,000 for American Indian diabetes prevention and control. The act included appropriations to managed care organization to provide medical assistance, chronic disease management and a case coordination program for every recipient of medical assistance diagnosed with specific diseases, including diabetes; the governor vetoed this provision. Act 2 (WI A 75)

Wyoming
Budget: Wyoming’s state budget does not appropriate money specifically for diabetes treatment or prevention. Chapter No. 39 (WY H 1)

CDC Funding for Diabetes Prevention and Control Programs (DPCPs), 2008-2010

The Centers for Disease Control and Prevention provides funding and technical assistance for diabetes prevention and control programs (DPCPs) in all 50 states, the District of Columbia, and 8 current and former U.S. territories.

These programs implement public health strategies such as:

• Preventing diabetes among people at highest risk.

• Adopting diabetes care guidelines in health care delivery settings.

• Helping state Medicaid programs monitor quality care outcomes among people with diabetes.

• Educating providers and the public about optimal diabetes care and self-management.

• Involving communities in diabetes control activities.

Table 2. CDC Funding for Diabetes Prevention and Control Programs (DPCPs), 2008-2010

The table below lists the state grants for 2008, 2009 and 2010. In 2010, the CDC granted $ 27,433,958 to states for diabetes prevention and control programs— $242,082 less than in 2009.

Footnotes

¹ Some states may allocate money to the treatment and prevention of diabetes that is not specifically delineated in a budget line item. Where this was the case, NCSL did not include those funds.

² Forty-six states begin their fiscal year (FY) on the first of July. The exceptions are New York on April 1, Texas on September 1, and Alabama and Michigan on October 1.