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Diabetes Health Coverage State Laws and Programs

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: May 2011; material added Nov. 2013

What this Report Covers

Nearly 26 million people in the United States have diabetes, equal to 8.3 percent of the total population.  According to the Centers for Disease Control and Prevention (CDC), about 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010 in the United States.  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 living.  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, which 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. 
  • Pre-Diabetes occurs 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. 

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 2007.

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. For more information about diabetes legislation, visit NCSL's Diabetes - State Legislation Overview.

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 billion in excess general medical costs

By 2012 the total cost of diabetes had increased to $245 billion,meaning that the disease’s toll on the economy has increased by more than 40 percent since 2007, according to a recent report from the American Diabetes Association.

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. For more information about state and CDC diabetes funding, visit NCSL's Diabetes in State Budgets: A 50-State Survey for Fiscal Year 2011.

Obesity and Diabetes

Obesity in persons with diabetes is associated with poorer control of blood glucose levels, blood pressure and cholesterol, 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 had a 2009 special project on obesity, available at http://www.ncsl.org/Default.aspx?tabid=14339

Diabetes and Native Americans

Diabetes affects American Indians/Alaskan 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. 

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 dependents 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 benefits 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 http://www.medicare.gov/Publications/Search/Results.asp?PubID=11022&Type=PubID&Language=English.
  • 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 cholesterol 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 http://www.medicare.gov/Publications/Search/Results.asp?PubID=11022&Type=PubID&Language=English.

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; covered 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) 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 governments 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 are programs supported by the Centers for Disease Control and Prevention (CDC). The 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 to the programs is less certain due to the current budget crisis. 

State Diabetes Coordinators were created to bring greater efficiencies 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 Tennessee 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 December 2012 based on NCSL research.

 Coverage for Supplies and Equipment

United States Map of State Diabetes Coverage Requirements within Private InsuranceFor 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 podiatry 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. 

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

Injectable Medication
Byetta (Exenatide) injection and Symlin (Pramlintide Acetate) injection, Victoza (lLiraglutide- rDNA origin) injection
Oral Medications

Acarbose, Avandia, Chlorpropamide, Diabinese, Glipizide, Glucophage, Glucotrol, Gylset, Meglitol, Metformin, Prandin, Precose, Repaglinide, Rosiglitazone (These drugs act in different ways to lower blood glucose levels and may be prescribed in combination with other medication.)

 

Examples of insulin pens and products
 

Illustration
© Novo-Nordisk

 supplies

Key/ Definitions

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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance

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.

 
Insurance Policies Required to Provide Coverage N/A
 
People Covered by Insurance Mandates N/A
 
Benefits Required
Medication:   No N/A 
Equipment and Supplies:  No N/A  
Education:  No  N/A 
Services:  No  N/A 
 
Copayments/Deductibles

N/A

 
Special Features and Issues

N/A

 
Statute Web Link

N/A

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered* Covered**
Disposable Needles:  Covered Covered**
Syringe Combinations:  Covered Covered**
Blood Glucose Strips:  Covered Covered**
  Notes: * 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 and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance

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 Mandates
  • Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin-using diabetes
 
Benefits Required
Medication:   Yes

Not specified. 

Equipment and 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?

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered 
Blood Glucose Strips:  Covered** Covered
  Notes: **Covered as durable medical equipment.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
 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 equipment and supplies.
 
People Covered by Insurance Mandates 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, podiatry 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  N/A 
Services:  No N/A
 
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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered  Covered 
Syringe Combinations:  Covered  Covered 
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance

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 Mandates
  • 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.

 
Special Features and Issues

N/A 

 
Statute Web Link

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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered with restrictions  Covered
Disposable Needles:  Covered with restrictions Covered
Syringe Combinations:  Covered with restrictions  Not covered
Blood Glucose Strips:  Not Covered Covered 
  Notes: N/A
 
Diabetes Prevention and Control Programs

Arkansas, Diabetes Control Program, Arkansas Department of Health
Visit the webiste here.

 

 

 California

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance

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 Mandates
  • 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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered  Covered 
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and Control Programs

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

 

 

 Colorado

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance

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 Mandates

“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 and 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?f=templates&fn=main-h.htm&cp=

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered 
Blood Glucose Strips:  Covered** Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the program Diabetes Disease Management. Program administrator: McKesson Health Solutions Inc. **Covered as durable medical equipment.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates
  • Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin-using diabetes
 
Benefits Required
Medication:   Yes

Not specified.

Equipment and 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://search.cga.state.ct.us/dtsearch_pub_statutes.html

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 (see below), if recommended in writing or prescribed by a physician.
 
People Covered by Insurance Mandates 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 N/A 
Services:  No N/A
 
Copayments/Deductibles

Not specified.

 
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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates Patients with diabetes; type of diabetes not specified.
 
Benefits Required
Medication:   N/A

Not mentioned.

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

Not specified.

 
Special Features and Issues

N/A

 
Statute Web Link

N/A

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: 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 and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance

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 Mandates
  • Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin-using diabetes
 
Benefits Required
Medication:   Yes Pharmacologic agents. 
Equipment and 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.

 
Special Features and Issues

 N/A

 
Statute Web Link

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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered*  Covered 
Disposable Needles:  Covered* Covered
Syringe Combinations:  Covered*  Covered
Blood Glucose Strips:  Covered* Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the Georgia Enhanced Care Program. Program administrator: Georgia Medicaid. *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 and Control Programs

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

 

 Hawaii

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates

Patients with diabetes; type of diabetes not specified.

 
Benefits Required
Medication:   N/A 

Not mentioned.

Equipment and Supplies:  Yes Not specified.  
Education:  Yes  Not specified, but medical nutritional therapy is not covered. 
Services:  Yes  Self-management training 
 
Copayments/Deductibles

Not specified.

 
Special Features and Issues

N/A

 
Statute Web Link

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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered
Blood Glucose Strips:  Covered** Covered
  Notes: **Covered as durable medical equipment.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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.

 
Insurance Policies Required to Provide Coverage N/A
 
People Covered by Insurance Mandates N/A
 
Benefits Required
Medication:  No N/A 
Equipment and Supplies:  No  N/A  
Education:  No N/A 
Services:  No N/A 
 
Copayments/Deductibles

N/A

 
Special Features and Issues

N/A

 
Statute Web Link

N/A 

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered
Blood Glucose Strips:  Covered** Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the program Pay for Performance Disease Management. Program administrator: Paul Leary, Medicaid Deputy Administrator. ** Covered as durable medical equipment.
 
Diabetes Prevention and Control Programs

Idaho Diabetes Control and Prevention Program Coordinator, Idaho Department of Health and Welfare
http://healthandwelfare.idaho.gov/Health/DiseasesConditions/Diabetes/tabid/175/Default.aspx

 

 Illinois

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
12,852,548 7,100 91,000 319,000 143,000 107,000 667,100 10,988,000
 
State Laws and Regulations

215 ILCS 5/356w - (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 Mandates
  • Type 1 diabetes
  • Type 2 diabetes
  • Gestational diabetes mellitus
 
Benefits Required
Medication:   Yes

Oral medications (to manage blood sugar). 

Equipment and Supplies:  Yes
  1. Blood glucose monitors.
  2. Cartridges.
  3. Lancets and lancing devices.
  4. Insulin.
  5. Syringes.
  6. Pen needles.
  7. Test strips.
  8. 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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered*  Covered* 
Disposable Needles:  Covered Covered 
Syringe Combinations:  Covered Covered 
Blood Glucose Strips:  Covered* Covered 
  Notes: *Covered with restrictions: Preferred drug list applies.
 
Diabetes Prevention and Control Programs

Illinois 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates 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 and 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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered* 
Disposable Needles:  Covered  Covered* 
Syringe Combinations:  Covered  Covered* 
Blood Glucose Strips:  Covered  Covered* 
  Notes: *Some yearly limits may apply.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates Patients with diabetes; all types of diabetes mellitus.
 
Benefits Required
Medication:   No N/A
Equipment and Supplies:  Yes  Blood glucose, meter and glucose strips for home monitoring.  
Education:  Yes  Not specified. 
Services:  Yes  Self-management training. 
 
Copayments/Deductibles

Not specified.

 
Special Features and Issues

N/A

 
Statute Web Link

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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered  Covered 
Syringe Combinations:  Covered  Covered 
Blood Glucose Strips:  Covered  Covered 
  Notes: Disease Management/Patient Education program includes diabetes under IME Care Management. Program administrator: Iowa Medicaid Enterprise.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance

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 Mandates
  • 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.

 
Special Features and Issues

N/A

 
Statute Web Link

http://www.kslegislature.org/li/statute/

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered
Disposable Needles:  Covered*** Covered
Syringe Combinations:  Covered*** Information not available
Blood Glucose Strips:  Covered** Covered
  Notes: 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. **Covered as durable medical equipment. ***Need prior authorization and covered as durable medical equipment.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates
  • 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 and 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.

 
Special Features and Issues

N/A 

 
Statute Web Link

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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered
Disposable Needles:  Not covered Not covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Not covered Not covered
  Notes: N/A
 
Diabetes Prevention and Control Programs

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

 

 Louisiana

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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. 22:1034. 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 Mandates
  • Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin using diabetes
 
Benefits Required
Medication:   N/A

Not mentioned.

Equipment and 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=507874

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates 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

Not specified.

 
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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered 
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates
  • Insulin-using diabetes
  • Non-insulin-dependent diabetes
  • Elevated blood glucose levels induced by pregnancy
 
Benefits Required
Medication:   N/A

Not mentioned.

Equipment and 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://law.justia.com/maryland/codes/2005/gin/15-706.html

 
Public Programs Medicaid CHIP
Prescribed Insulin:   Covered  Covered
Disposable Needles:  Covered Covered
Syringe Combinations:   Covered  Covered
Blood Glucose Strips:  Covered**   Covered 
  Notes: ** Covered as durable medical equipment.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates
  • 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

Not specified.

 
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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and Control Programs

Massachusetts Diabetes Prevention and Control Program, Massachusetts Department of Health and Human Services
http://www.mass.gov/dph/diabetes 

 

 Michigan

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates
  • 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

Not specified.

 
Special Features and Issues

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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered** Covered
Blood Glucose Strips:  Covered** Covered
  Notes: **Covered as durable medical equipment.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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, clause 1 (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 Mandates
  • Type I diabetes
  • Type II diabetes
  • Gestational diabetes
 
Benefits Required
Medication:   Yes 

Not specified.

Equipment and 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.

 
Special Features and Issues

N/A

 
Statute Web Link

www.revisor.mn.gov/bin/getpub.php?pubtype=stat_chap&year=2007§ion=62a

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Limited coverage
Blood Glucose Strips:  Covered** Covered
  Notes: Medicare Part D: 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.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates 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 and 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?f=templates&fn=main-h.htm&cp=

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Limited coverage
Disposable Needles: Not covered Limited coverage
Syringe Combinations:  Not covered Limited coverage 
Blood Glucose Strips:  Not covered Limited coverage
  Notes: Pays pharmacies $20 for average 30-minute encounter for disease management services for specified disorders, including diabetes.
 
Diabetes Prevention and 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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
 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 Mandates
  • Type I diabetes
  • Type II diabetes
  • Gestational diabetes
 
Benefits Required
Medication:   N/A

Not mentioned.

Equipment and 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.

 
Special Features and Issues

N/A

 
Statute Web Link

Web link not available for statute.

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  N/A
Disposable Needles:  Covered N/A
Syringe Combinations:  Covered N/A
Blood Glucose Strips:  Covered N/A
  Notes: 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.
 
Diabetes Prevention and Control Programs

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

 

 Montana

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates 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. 

 
Special Features and Issues

N/A

 
Statute Web Link

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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered*** Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered
Blood Glucose Strips:  Covered**  Covered
  Notes: **Covered as durable medical equipment. ***Need prior authorization.
 
Diabetes Prevention and Control Programs

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 Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates
  • 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.

 
Special Features and Issues

N/A

 
Statute Web Link

http://uniweb.legislature.ne.gov/laws/statutes.php?statute=44-790

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered*** Covered***
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered**  Covered
Blood Glucose Strips:  Covered** Covered
  Notes:**Covered as durable medical equipment. ***Need prior authorization.
 
Diabetes Prevention and Control Programs

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

 

 Nevada

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates
  • 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.

 
Special Features and Issues

N/A 

 
Statute Web Link

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

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and Control Programs

Nevada Diabetes Prevention & Control Program, Nevada Department of Health and Human Services
http://health.nv.gov/CD_Diabetes.htm

 

 New Hampshire

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
1,315,828 700 10,000 27,000 15,000 12,000 65,700  
 
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 Mandates 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

Not specified.

 
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 

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered*
Disposable Needles:  Covered Covered*
Syringe Combinations:  Covered  Covered*
Blood Glucose Strips:  Covered  Covered* 
  Notes: * Co-pay required.
 
Diabetes Prevention and Control Programs

New Hampshire Diabetes Education Program, New Hampshire Department of Health & Human Services
http://www.dhhs.nh.gov/dphs/cdpc/diabetes/

 

 New Jersey

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
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 Mandates 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

N/A

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and Control Programs

New Jersey Diabetes Prevention & Control, New Jersey Department of Health & Senior Services
http://www.state.nj.us/health/fhs/diabetes/index.shtml

 

 New Mexico

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
1,969,915 1,100 16,000 43,000 21,000 15,000 97,100 1,509,000
 
State Laws and Regulations NM ST §59A-22-41: Individual and group health insurance policy; NM ST §59A-46-43: Individual and group health maintenance organization contract.
Date enacted: 1997.
 
Insurance Policies Required to Provide Coverage Each individual and group health insurance policy, health care plan, certificate of health insurance and managed health care plan delivered or issued for delivery in the state, and each individual and group health maintenance organization contract delivered or issued for delivery in the state.
 
People Covered by Insurance Mandates
  • Insulin-using diabetes
  • Non-insulin-using diabetes
  • Elevated blood glucose levels induced by pregnancy
 
Benefits Required
Medication:   Yes

Insulin. 

Equipment and Supplies:  Yes
  1. Blood glucose monitors, including those for the legally blind.
  2. Test strips for blood glucose monitors.
  3. Visual reading urine and ketone strips.
  4. Lancets and lancet devices.
  5. Injection aids, including those adaptable to meet the needs of the legally blind.
  6. Syringes.
  7. Prescriptive oral agents for controlling blood sugar levels.
  8. Medically necessary podiatric appliances for prevention of feet complications associated with diabetes, including therapeutic molded or depth-inlay shoes, functional orthotics, custom molded inserts, replacement inserts, preventive devices and shoe modifications for prevention and treatment.
  9. Glucagon emergency kits.
Education:  Yes Medical nutrition therapy included.
Services:  Yes Self-management training.
 
Copayments/Deductibles

Coverage for people with diabetes may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same contract, as long as the annual deductibles or coinsurance for benefits are no greater than the annual deductibles or coinsurance established for similar benefits within a given contract.

 
Special Features and Issues

N/A

 
Statute Web Link

http://www.conwaygreene.com/nmsu/lpext.dll?f=templates&fn=main-h.htm&2.0

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and Control Programs

New Mexico Diabetes Prevention & Control Program, New Mexico Department of Health
http://www.diabetesnm.org/

 

 New York

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
19,297,729 10,000 171,000 524,000 243,000 201,000 1,160,000 16,543,000
 
State Laws and Regulations NY INS §3216: Individual accident and health insurance policy provisions; NY INS § 3221: Group or blanket accident and health insurance policies; NY INS §4303: Benefits; NY INS §4321: Standardization of individual enrollee direct payment contracts offered by HMOs. Date: 1993.
 
Insurance Policies Required to Provide Coverage Individual accident and health insurance policy provisions; group or blanket accident and health insurance policies; medical expense indemnity corporation and health service corporations; and direct payment contracts offered by health maintenance organizations.
 
People Covered by Insurance Mandates Patients with diabetes; Type of diabetes not specified because mandate is not based on the type of diabetes or whether the patient uses insulin.
 
Benefits Required
Medication:   Yes
  1. Insulin.
  2. Oral agents for controlling blood sugar.
  3. Oral agents for treating hypoglycemia (e.g. glucose tablets and gels). 
Equipment and Supplies:  Yes
  1. Lancets and automatic lancing devices. 
  2. Glucose test strips. 
  3. Alcohol swabs, skin prep wipes and IV prep (for cleaning skin). 
  4. Blood glucose monitors (e.g. glucometers). 
  5. Blood glucose monitors for the visually impaired. 
  6. Control solutions used in blood glucose monitors. 
  7. Diabetes data management systems to manage blood glucose. 
  8. Urine testing products for glucose and ketones. 
  9. Insulin infusion devices. 
  10. Injection aids (e.g. insulin drawing-up devices for the visually impaired). 
  11. Cartridges for the visually impaired. 
  12. Disposable injectable insulin cartridges and pen cartridges. 
  13. Other disposable injectable medication cartridges and pen needles used for diabetes therapies. 
  14. Glucagon emergency kits.
  15. Syringes. 
  16. Insulin pumps, equipment and supplies for use of the pump (e.g. batteries, semi-permeable transparent dressings, insertion devices, insulin infusion sets, reservoirs, cartridges, clips, skin adhesive and skin adhesive remover, tools specific to prescribed pump).
Education:  Yes Not specified.
Services:    Self-management training.
 
Copayments/Deductibles

Subject to same deductibles/copayments as required for similar types of benefits in the insurance policy or contract.

 
Special Features and Issues

The law does not apply to:

  • Medicaid recipients,
  • Union-sponsored benefit plans that are self-insured,
  • Medicare or Medigap (Medicare supplemental policies) beneficiaries,
  • Plans that insure employees in more than one state,
  • Employer-sponsored benefit plans that are self-insured, and 
  • Health insurance policies that are not issued in New York State.
Section 4303(u) of the New York Insurance Law requires coverage for diabetic equipment and supplies (this includes insulin and oral agents for controlling blood sugar, among other things).  They carry a copayment; however that copayment would be whatever the office visit co-payment is under that policy.  The NY state Insurance Department has allowed diabetic equipment and supplies to be included under a drug rider but only where the drug rider co-payment was equal to or less than the co-pay that would be applicable under the medical benefit. 
 
Statute Web Link

http://public.leginfo.state.ny.us/menugetf.cgi?COMMONQUERY=LAWS

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: Disease Management/Patient Education Program includes diabetes under Diabetes Prevention and Control. Program administrator: Bureau of Chronic Disease Services, New York State Department of Health.
 
Diabetes Prevention and Control Programs

New York State Diabetes Prevention and Control Program, New York State Department of Health
http://www.nyhealth.gov/diseases/conditions/diabetes/

 

 North Carolina

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
9,061,032 5,000 79,000 253,000 113,000 96,000 548,000 7,673,000
 
State Laws and Regulations NC ST § 58-51-61: Policy or contract of accident or health insurance; NC ST § 58-65-91: Hospital service plan or medical service plan; NC ST §58-67-74: Health maintenance organization. Date enacted: 1997.
 
Insurance Policies Required to Provide Coverage Every policy or contract of accident or health insurance, every preferred provider benefit plan (PPO), every insurance certificate or subscriber contract under any hospital service plan or medical service plan, and every health care plan written by a health maintenance organization (HMO).
 
People Covered by Insurance Mandates Patients with diabetes; type of diabetes not specified.
 
Benefits Required
Medication:   Yes Not specified. 
Equipment and Supplies:  Yes  Not specified.  
Education:  Yes Not specified. 
Services:  Yes  Diabetes outpatient self-management training.
 
Copayments/Deductibles

The same deductibles, coinsurance and other limitations as apply to similar services covered under the policy, contract or plan shall apply to the diabetes coverage required under this section.

 
Special Features and Issues

N/A

 
Statute Web Link

http://www.ncleg.net/enactedlegislation/statutes/html/bysection/chapter_58/gs_58-51-61.html

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered* 
Disposable Needles:  Covered Covered*
Syringe Combinations:  Covered Covered* 
Blood Glucose Strips:  Covered Covered* 
  Notes: * Co-pays required.  Members of certain Native American tribes are exempted from co-pays.
 
Diabetes Prevention and Control Programs

North Carolina Diabetes Prevention and Control Branch, North Carolina Division of Public Health
http://www.ncdiabetes.org/aboutUs/index.asp

 

 North Dakota

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
639,715 300 4,000 11,000 7,000 8,000 31,300 553,000
 
State Laws and Regulations No applicable statute.  North Dakota is one of four states that does not have a mandate or insurance requirement specific to diabetes coverage.
 
Insurance Policies Required to Provide Coverage N/A
 
People Covered by Insurance Mandates N/A
 
Benefits Required
Medication:   No 

N/A 

Equipment and Supplies:  No  N/A  
Education:  No  N/A 
Services:  No  N/A 
 
Copayments/Deductibles

N/A 

 
Special Features and Issues

N/A 

 
Statute Web Link

N/A 

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered  Covered 
Blood Glucose Strips:  Covered Covered 
  Notes: N/A
 
Diabetes Prevention and Control Programs

North Dakota Diabetes Prevention and Control Program, North Dakota Department of Health
http://www.diabetesnd.org/

 

 Ohio

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
11,466,917 6,100 112,000 293,000 157,000 104,000 675,100 9,979,000
 
State Laws and Regulations No applicable statute. Ohio is one of four states that does not have a mandate or insurance requirement specific to diabetes coverage.
 
Insurance Policies Required to Provide Coverage N/A 
 
People Covered by Insurance Mandates N/A 
 
Benefits Required
Medication:   No

N/A

Equipment and Supplies:  No  N/A  
Education:  No  N/A 
Services:  No  N/A 
 
Copayments/Deductibles

N/A 

 
Special Features and Issues

N/A 

 
Statute Web Link

N/A 

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered 
Blood Glucose Strips:  Covered** Covered 
  Notes: **Covered as durable medical equipment.
 
Diabetes Prevention and Control Programs

Ohio Diabetes Prevention and Control Program, Ohio Department of Health
http://www.odh.ohio.gov/odhPrograms/hprr/diabete/diab1.aspx

 

 Oklahoma

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
3,617,316 2,000 37,000 103,000 47,000 37,000 227,000 2,920,000
 
State Laws and Regulations OK ST T. 36 §6060.2. Date enacted: 1996.
 
Insurance Policies Required to Provide Coverage For policies, contracts or agreements issued or renewed on and after Nov 1, 1996, any individual or group health insurance policy, contract or agreement providing coverage on an expense-incurred basis; any policy, contract or agreement issued for individual or group coverage by a not-for-profit hospital service and indemnity and medical service and indemnity corporation; contracts issued by health benefit plans including, but not limited to, health maintenance organizations, preferred provider organizations, health services corporations, physician-sponsored networks, or physician hospital organizations; medical coverage provided by self-insureds that includes coverage for physician services in a physician’s office, including coverage through private third-party payers; coverage provided through the State and Education Employees Group Insurance Board; and every policy, contract or agreement that provides medical, major medical or similar comprehensive type coverage, group or blanket accident and health coverage, or medical expense, surgical, medical equipment, medical supplies, or drug prescription benefits shall, subject to the terms of the policy contract or agreement, include coverage for equipment, supplies and related services.
 
People Covered by Insurance Mandates
  • Type I diabetes
  • Type II diabetes
  • Gestational diabetes
  • Coverage applies when medically necessary and when recommended or prescribed by a physician or other licensed health care provider legally authorized to prescribe under state laws.
 
Benefits Required
Medication:   Yes 
  1. Insulin.
  2. Oral agents for controlling blood sugar.
Equipment and Supplies:  Yes 
  1. Blood glucose monitors.
  2. Blood glucose monitors to the legally blind.
  3. Test strips for glucose monitors.
  4. Visual reading and urine testing strips.
  5. Injection aids.
  6. Cartridges for the legally blind.
  7. Syringes.
  8. Insulin pumps and appurtenances thereto.
  9. Insulin infusion devices.
  10. Podiatric appliances for prevention of complications associated with diabetes.
Education:  Yes Medical nutritional therapy included.
Services:  Yes Diabetes self-management training.
 
Copayments/Deductibles

May be subject to the same annual deductibles or coinsurance as may be deemed appropriate and as are consistent with those established for other covered policy benefits.

 
Special Features and Issues

N/A

 
Statute Web Link

http://webserver1.lsb.state.ok.us/OK_Statutes/CompleteTitles/os36.rtf

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered
Blood Glucose Strips:  Covered**  Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the program Pediatric Diabetes Management. Program administrator: Mike Herndon, D.O.**Covered as durable medical equipment.
 
Diabetes Prevention and Control Programs

Oklahoma Diabetes Prevention and Control Program, Oklahoma State Department of Health
Visit the website

 

 Oregon

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
3,747,455 2,000 32,000 82,000 37,000 30,000 184,000 3,130,000
 
State Laws and Regulations

OR ST §743.694. Date enacted: 2001.

 
Insurance Policies Required to Provide Coverage Group health benefit plans as described in OR ST §743.730 (which specifies that a health benefit plan means any hospital expense, medical expense, or hospital or medical expense policy or certificate, health care service contractor or health maintenance organization subscriber contract).
 
People Covered by Insurance Mandates
  • Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin-using diabetes
 
Benefits Required
Medication:   No 

N/A

Equipment and Supplies:  Yes  Not specified.  
Education:  Yes  An education program credentialed or accredited by a qualified state or national entity.
Services:  Yes  Diabetes self-management program.
Coverage for Amputees: Yes

See below under "Special features and issues" for more detailed information.

 
Copayments/Deductibles

Not specified.

 
Special Features and Issues

Coverage for Amputees: HB 2517: Requires coverage under health insurance policy for prosthetic and orthotic devices

 
Statute Web Link

http://www.leg.state.or.us/ors/743a.html

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered
Blood Glucose Strips:  Covered**  Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the program Care Enhance. Program administrator: McKesson. **Covered as durable medical equipment.
 
Diabetes Prevention and Control Programs

Oregon Diabetes Program, Oregon Department of Human Services
http://www.oregon.gov/DHS/ph/diabetes/

 

 Pennsylvania

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
12,432,792 6,300 116,000 304,000 174,000 165,000 768,300 11,138,000
 
State Laws and Regulations 40 P.S. §764e. Date enacted: 1998.
 
Insurance Policies Required to Provide Coverage Any individual or group health, sickness and accident insurance policy, group health insurance plans/policies, and all other forms of managed/capitated care plans/policies or subscriber contract or certificate issued by any entity subject to 40 Pa.C.S. Ch. 61 (relating to hospital plan corporations) or Ch. 63 (relating to professional health services plan corporations) or the act of Dec 29, 1972 (P.L. 1701, No. 364), [FN1] known as the “Health Maintenance Organization Act,” the act of Dec 14, 1992 (P.L. 835, No. 134), [FN2] known as the “Fraternal Benefit Societies Code,” or this act providing hospital or medical/surgical coverage. This section does not include the following policies: accident only, fixed indemnity, limited benefit, credit, dental, vision, specified disease, Medicare supplement, CHAMPUS (Civilian Health and Medical Program for the Uniform Services) supplement, long-term care, disability income, workers’ compensation or automobile medical payment.
 
People Covered by Insurance Mandates
  •  Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin-using diabetes
 
Benefits Required
Medication:   Yes 
  1. Insulin.
  2. Pharmacological agents for controlling blood sugar and orthotics.
Equipment and Supplies:  Yes 
  1. Blood glucose monitors.
  2. Monitor supplies.
  3. Injection aids.
  4. Syringes.
  5. Insulin infusion devices.
Education:  Yes Medical nutritional therapy included.
Services:  Yes Outpatient self-management training.
 
Copayments/Deductibles

Subject to the annual deductibles or coinsurance requirements imposed for similar coverage under the same health policy. 

 
Special Features and Issues

N/A 

 
Statute Web Link

http://www.legis.state.pa.us/WU01/LI/LI/CT/HTM/40/40.HTM

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered  Covered
Blood Glucose Strips:  Covered  Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the program AccessPlus. Program administrator: McKesson.
 
Diabetes Prevention and Control Programs

Pennsylvania Diabetes Prevention & Control Program, Pennsylvania Department of Health
http://www.portal.state.pa.us/portal/server.pt/community/diabetes/14160

 

Rhode Island

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
1,057,832 500 10,000 21,000 13,000 14,000 57,500 931,000
 
State Laws and Regulations RI ST §27-18-38: Accident and sickness policy; RI ST §27-19-35: Nonprofit hospital service corporations; RI ST § 27-20-30: Nonprofit medical service corporations; RI ST §27-41-44: Health maintenance organizations. Date enacted: 1996.
 
Insurance Policies Required to Provide Coverage Accident and sickness insurance policies, nonprofit hospital service corporations, nonprofit medical service corporations, and health maintenance organizations.
 
People Covered by Insurance Mandates
  • Insulin treated diabetes
  • Non-insulin treated diabetes
  • Gestational diabetes
 
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/or visual reading.
  3. Injection aids.
  4. Cartridges for the legally blind.
  5. Syringes.
  6. Insulin pumps and appurtenances to the pumps.
  7. Insulin infusion devices.
  8. Therapeutic/molded shoes to prevent amputation.
Education:  Yes

Medical nutritional therapy included.

Services:  Yes  Self-management education/training.
Coverage for Amputees:  Yes See below under "Special features and issues" for more detailed information.
 
Copayments/Deductibles

Not specified.

 
Special Features and Issues

Coverage for Amputees: 27-18-39: Coverage for prostheses and treatment of physical complications.

 
Statute Web Link

http://www.rilin.state.ri.us/Statutes/TITLE27/27-18/27-18-38.HTM

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: **Covered as durable medical equipment.
 
Diabetes Prevention and Control Programs

Rhode Island Diabetes Prevention and Control Program, Rhode Island Department of Health
http://www.health.ri.gov/disease/diabetes/index.php

 

South Carolina

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
4,407,709 2,400 47,000 140,000 62,000 46,000 299,400 3,664,000
 
State Laws and Regulations SC ST § 38-71-46. Date enacted: 1999.
 
Insurance Policies Required to Provide Coverage

On or after Jan 1, 2000, every health maintenance organization, individual and group health insurance policy, or contract issued or renewed in state must provide coverage.

 
People Covered by Insurance Mandates Diabetes mellitus
 
Benefits Required
Medication:   Yes

Not specified.

Equipment and Supplies:  Yes Not specified.
Education:  Yes Not specified.
Services:  Yes Outpatient self-management training.
 
Copayments/Deductibles

Not specified. 

 
Special Features and Issues

N/A 

 
Statute Web Link

http://www.scstatehouse.gov/cgi-bin/query.exe?first=DOC&querytext=diabetes&category=Code&conid=6171490&result_pos=0&keyval=671

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered  Covered
Blood Glucose Strips:  Covered  Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the program Diabetes Chronic Care Management. Program administrator: South Carolina Department of Health and Human Services.**Covered as durable medical equipment.
 
Diabetes Prevention and Control Programs

South Carolina Diabetes Prevention & Control Program, S.C. Department of Health and Environmental Control
http://www.scdhec.gov/health/chcdp/diabetes/

 

South Dakota

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
796,214 400 5,000 14,000 8,000 9,000 37,400 708,000
 
State Laws and Regulations SD ST §58-17-1.2: Individual policies; SD ST §58-17-1.3: Diabetes coverage not required of 58-17-1.2; SD ST §58-18-83: Group health insurance policy; SD ST §58-18-84: Not required coverage of 58-18-83; SD ST §58-18B-56: Small businesses' group and blanket health insurance; SD ST §58-18B-57: Not required coverage of 58-18B-56; SD ST §58-38-42: Nonprofit medical and surgical plans; SD ST §58-38-43: Not required coverage of 58-38-42; SD ST §58-40-39: Nonprofit hospital service plans; SD ST §58-40-40: Not required coverage of 58-40-39; SD ST §58-41-117: Health maintenance organizations; SD ST §58-41-118: Not required coverage of 58-41-117. Date enacted: 1999.
 
Insurance Policies Required to Provide Coverage Health insurance policies, group and blanket health insurance policies, regulation of small businesses’ group and blanket health insurance, nonprofit medical and surgical plans, nonprofit hospital service plans, and health maintenance organizations.
 
People Covered by Insurance Mandates Patients with diabetes; Type of diabetes not specified.
 
Benefits Required
Medication:   Yes
  1. Insulin.
  2. Oral agents for controlling blood sugars.
Equipment and Supplies:  Yes
  1. Blood glucose monitors for the legally blind.
  2. Test strips for glucose monitors.
  3. Urine testing strips.
  4. Injection aids.
  5. Lancets.
  6. Lancet devices.
  7. Syringes.
  8. Insulin pumps and all supplies for the pump.
  9. Insulin infusion devices prescribed.
  10. Glucose agents.
  11. Glucagon kits.
  12. Insulin measurement and administration aids for the visually impaired.
  13. Other medical devices for treatment of diabetes.
Education:  Yes Medical nutrition therapy included.
Services:  Yes Diabetes self-management training.
 
Copayments/Deductibles

The benefits provided in this section are subject to the same dollar limits, deductibles, coinsurance and other restrictions established for all other benefits covered in the policy.

 
Special Features and Issues

N/A

 
Statute Web Link

http://legis.state.sd.us/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-17-1.2 

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and Control Programs

South Dakota Diabetes Prevention & Control Program, South Dakota Department of Health
http://doh.sd.gov/Diabetes/

 

Tennessee

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
6,156,719 3,300 62,000 196,000 83,000 48,000 395,300 5,268,000
 
State Laws and Regulations TN ST § 56-7-2605.  Date enacted: 1997.
 
Insurance Policies Required to Provide Coverage

Any individual, franchise, blanket or group health insurance policy; medical service plan; contract; hospital service corporation contract; hospital and medical service corporation contract; fraternal benefit society; health maintenance organization; preferred provider organization or managed care organization that provides hospital, surgical or medical expense insurance.

 
People Covered by Insurance Mandates “Patient with diabetes” refers to anyone with elevated blood glucose levels that has been diagnosed as having diabetes by an appropriately licensed health care professional.
 
Benefits Required
Medication:   Yes 
  1. Insulin.
  2. Oral hypoglycemic agents.
Equipment and Supplies:  Yes
  1. Blood glucose monitors and blood glucose monitors for the legally blind.
  2. Test strips for blood glucose monitors.
  3. Visual reading and urine test strips.
  4. Injection aids.
  5. Syringes.
  6. Lancets.
  7. Insulin pumps, infusion devices and appurtenances.
  8. Podiatric appliances for prevention of complications associated with diabetes.
  9. Glucagon emergency kits.
Education:  Yes

Medical nutrition counseling included.

Services:  Yes Diabetes outpatient self-management training.
 
Copayments/Deductibles

The benefits required by this section may be subject to the annual deductible and coinsurance established for all other similar benefits within a given policy, program or contract of insurance, so long as the annual deductible and coinsurance for the benefits required by this section are no greater than the annual deductible and coinsurance established for all other similar benefits within that policy, program, or contract of insurance.

 
Special Features and Issues

N/A

 
Statute Web Link

http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: CoverRx provides the generic equivalent of the following popular brand drugs: Glucophage® (metformin) and the following covered brand drugs: Lantus®*, Novolin®*, NovoLog®* Patient cost is based on a personal income sliding scale: Up to 100% FPL  = $5; 100 -149% FPL = $8; 150-249% FPL = $12.  (updated 11/09) Website: http://www.covertn.gov/web/coverrx_benefits.html
 
Diabetes Prevention and Control Programs

Tennessee Project Diabetes, run by the Tennessee Department of Health
http://health.state.tn.us/projectdiabetes.htm

 

Texas

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
23,904,380 14,600 211,000 638,000 259,000 151,000 1,279,600 17,742,000
 
State Laws and Regulations TX INS §1358.001: Definition; TX INS §1358.002: Applicability; TX INS §1358.003: Exceptions; TX INS §1358.004: Adoption of minimum standards; TX INS §1358.005: Coverage required; TX INS §1358.051: Definitions; TX INS §1358.052: Applicability; TX INS §1358.053: Exception; TX INS §1358.054: Coverage required; TX INS §1358.055: Diabetes self-management training; TX INS §1358.056: Coverage for new or improved equipment; TX INS §1358.057: Rules; TX INS §1501.0581: Health group cooperatives; TX INS §1507.003: State-mandated health benefits; TX INS §1551.219: Group benefits; TX INS §1575.164: Public school employees group benefits program; TX INS §1601.110: Uniform insurance benefits for employees of the University of Texas system and the Texas A&M University System; TX INS Art. 1.53D. Date enacted: 1997.
 
Insurance Policies Required to Provide Coverage This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident or sickness, including:(1) an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage that is offered by: an insurance company; a group hospital service corporation operating under Chapter 842; a fraternal benefit society operating under Chapter 885; a stipulated premium company operating under Chapter 884; or a health maintenance organization operating under Chapter 843. To the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by: a multiple employer welfare arrangement as defined by Section 3 of that Act; or another analogous benefit arrangement; and health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code, notwithstanding Section 172.014, Local Government Code, or any other law. A health benefit plan provided through a health group cooperative or group benefits program must provide coverage for diabetes equipment, supplies and services as required by Subchapter B, Chapter 1358. This subchapter does not apply to a plan that provides coverage only for a specified disease; only for accidental death or dismemberment; for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; as a supplement to a liability insurance policy; only for dental or vision care; only for indemnity for hospital confinement; a small employer health benefit plan written under Chapter 1501; a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); a workers’ compensation insurance policy; medical payment insurance coverage provided under a motor vehicle insurance policy; or a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1358.002.
 
People Covered by Insurance Mandates “Qualified enrollee” refers to anyone who is eligible for health care coverage under a health benefit plan and who has been diagnosed with:
  • Insulin dependent diabetes
  • Non-insulin dependent diabetes
  • Elevated blood glucose levels induced by pregnancy
  • Another medical condition associated with elevated blood glucose levels
 
Benefits Required
Medication:   Yes

All supplies, including medications and equipment for the control of diabetes shall be dispensed as written, including brand-name products, unless substitution is approved by the physician or practitioner who issues the written order for the supplies or equipment.

Equipment:  Yes
  1. Blood glucose monitors, including noninvasive glucose monitors and glucose monitors designed to be used by the blind.
  2. Insulin pumps and associated appurtenances.                              
  3. Insulin infusion devices.                                            
  4. Podiatric appliances to prevent complications associated with diabetes.
Supplies:  Yes
  1. Test strips for blood glucose monitors.                                  
  2. Visual reading and urine test strips.                                    
  3. Lancets and lancet devices.                                              
  4. Insulin and insulin analogs.                                            
  5. Injection aids.                                                          
  6. Syringes.                                                                
  7. Prescriptive and non-prescriptive oral agents for controlling blood sugar levels. 
  8. Glucagon emergency kits.
Education:  Yes Nutrition counseling and instructions on proper use of diabetes equipment and supplies shall be provided or covered.
Services:  Yes Diabetes self-management training.
 
Copayments/Deductibles

A health benefit plan can require a deductible, copayment or coinsurance for coverage provided under this section.   The amount of the deductible, copayment or coinsurance may not exceed the amount of the deductible, copayment or  coinsurance  required for treatment of other analogous chronic medical conditions.

 
Special Features and Issues

N/A

 
Statute Web Link

http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1358.htm

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the program Texas Medicaid Enhanced Care Program. Program administrator: Texas Health and Human Services Commission. 
 
Diabetes Prevention and Control Programs

Texas Diabetes Council, Texas Department of State Health Services
http://www.dshs.state.tx.us/diabetes/
http://www.dshs.state.tx.us/diabetes/tdcdaecs.shtm

 

Utah

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
2,645,330 2,000 19,000 34,000 19,000 14,000 89,000 2,317,000
 
State Laws and Regulations UT ST §31A-22-626. Date enacted: 2000.
 
Insurance Policies Required to Provide Coverage The commissioner shall establish, by rule, minimum standards of coverage for diabetes for accident and health insurance policies that provide a health insurance benefit before July 1, 2000.
 
People Covered by Insurance Mandates
  • Complete insulin deficiency or type I diabetes
  • Insulin resistant with partial insulin deficiency or type II diabetes
  • Elevated blood glucose levels induced by pregnancy (gestational diabetes)
 
Benefits Required
Medication:   Yes
  1. Insulin.
  2. Prescriptive oral agents for controlling blood glucose levels. 
Equipment and Supplies:  Yes
  1. Blood glucose monitors, including those for the legally blind.
  2. Test strips for blood glucose monitors.
  3. Visual reading urine and ketone strips.
  4. Lancets and lancet devices.
  5. Injection aides, including those adaptable to meet the needs of the legally blind, and infusion delivery systems.
  6. Syringes. 
  7. Glucagon kits.
Education:  Yes Medical nutrition therapy included.
Services:  Yes Diabetes self-management training and patient management.
 
Copayments/Deductibles

Durational limits, amount limits, deductibles and coinsurance for treatment of diabetes are to be equitable or identical to coverage provided for treatment of other illnesses or diseases.

 
Special Features and Issues

N/A 

 
Statute Web Link

http://le.utah.gov/~code/TITLE31A/htm/31A22_062600.htm

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered 
  Notes: N/A
 
Diabetes Prevention and Control Programs

Utah Diabetes Prevention and Control Program, Utah Department of Health
http://health.utah.gov/diabetes/

 

Vermont

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
621,254 300 5,000 12,000 6,000 5,000 27,300 545,000
 
State Laws and Regulations VT ST T. 8 §4089c. Date enacted: 1997.
 
Insurance Policies Required to Provide Coverage

"Insurer” defined as any health insurance company, nonprofit hospital and medical service corporation, and health maintenance organization. The term does not apply to limited coverage for specified disease or other limited benefit coverage.

 
People Covered by Insurance Mandates
  • Insulin dependent diabetes
  • Insulin using diabetes
  • Gestational diabetes
  • Non-insulin-using diabetes
 
Benefits Required
Medication:   Yes Not specified.
Equipment and 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 required to be covered by this section shall be subject to the same dollar limits, deductibles and coinsurance factors within the provisions of the health insurance policy.

 
Special Features and Issues

Coverage of Amputees: § 4088f: Prosthetic parity.

 
Statute Web Link

http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=08&Chapter=107&Section=04089c

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: N/A
 
Diabetes Prevention and Control Programs

Vermont Diabetes Prevention and Control Program, Vermont Department of Health.
http://healthvermont.gov/prevent/diabetes/diabetes.aspx

 

Virginia

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
7,712,091 4,100 60,000 182,000 85,000 68,000 400,100 6,548,000
 
State Laws and Regulations VA ST §38.2-3418.10. Date enacted: 2000.
 
Insurance Policies Required to Provide Coverage Each insurer that proposes to issue an individual or group hospital policy or major medical policy in the Commonwealth, each corporation proposing to issue an individual or group hospital, medical or major medical subscription contract, and each health maintenance organization providing a health care plan for health care services shall provide coverage for diabetes as provided in this section. The requirements of this section shall apply to all insurance policies, contracts and plans delivered, issued for delivery, reissued, or extended on and after July 1, 2000, or at any time thereafter when any term of the policy, contract or plan is changed or any premium adjustment is made.
 
People Covered by Insurance Mandates
  • Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin-using diabetes
 
Benefits Required
Medication:   Yes

Not specified. 

Equipment and Supplies:  Yes Not specified.
Education:  Yes Medical nutrition therapy included.
Services:  Yes In-person outpatient self-management training.
 
Copayments/Deductibles

No insurer, corporation or health maintenance organization shall impose upon any person receiving benefits pursuant to this section any copayment, fee or condition that is not equally imposed upon all individuals in the same benefit category, nor shall any insurer, corporation or health maintenance organization impose any policy-year or calendar-year dollar or durational benefit limitations or maximums for benefits or services provided under this section.

 
Special Features and Issues

N/A

 
Statute Web Link

http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+38.2-3418.10

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered* 
Disposable Needles:  Covered** Covered*
Syringe Combinations:  Covered Covered* 
Blood Glucose Strips:  Covered**  Covered* 
  Notes: Disease Management/Patient Education Program includes diabetes. Program administrator: HMC Inc.**Covered as durable medical equipment.  Co-pays required.
 
Diabetes Prevention and Control Programs

Virginia Diabetes Prevention & Control Project (DPCP), Virginia Department of Health.
http://www.vahealth.org/cdpc/diabetes/

 

Washington

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
6,468,424 3,400 49,000 140,000 55,000 52,000 299,400 5,773,000
 
State Laws and Regulations WA ST 48.20.391: Disability insurance; WA ST 48.21.143: Group and blanket disability insurance; WA ST 48.44.315: Health care services; WA ST 48.46.272: Health maintenance organizations. Date enacted: 1997.
 
Insurance Policies Required to Provide Coverage Washington 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. All health benefit plans offered by health maintenance organizations (HMOs) and all group disability insurance contracts and blanket disability insurance contracts.
 
People Covered by Insurance Mandates
  • Insulin using diabetes
  • Non-insulin using diabetes
  • Elevated blood glucose levels induced by pregnancy
 
Benefits Required
Medication:   Yes
  1. Insulin.
  2. Prescriptive oral agents for controlling blood sugar levels.
Equipment:  Yes
  1. Syringes.
  2. Injection aids.
  3. Blood glucose monitors.
  4. Test strips for blood glucose monitors.
  5. Visual reading and urine test strips.
  6. Insulin pumps and accessories to the pumps.
  7. Insulin infusion devices.
  8. Foot care appliances for prevention of complications associated with diabetes.
  9. Glucagon emergency kits.
Supplies:  Yes Not specified.
Education:  Yes Medical nutritional therapy included.
Services:  Yes Outpatient self-management training.
 
Copayments/Deductibles

Coverage required under this section may be subject to customary cost-sharing provisions established for all other similar services or supplies within a policy.

 
Special Features and Issues

Coverage for diabetes equipment and supplies is required only when the contract or insurance policy provides for prescription coverage.

 
Statute Web Link

http://apps.leg.wa.gov/RCW/default.aspx?cite=48.20.391

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: Disease Management/Patient Education Program includes diabetes. Program administrator: McKesson.
 
Diabetes Prevention and Control Programs

Washington Diabetes Prevention & Control Program, Washington State Department of Health
http://www.doh.wa.gov/cfh/diabetes/

 

West Virginia

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
1,812,035 900 25,000 66,000 32,000 29,000 152,900 1,541,000
 
State Laws and Regulations WV ST § 33-15C-1: Diabetes insurance; WV ST § 33-16-16: Group accident or sickness policy; WV ST §33-25E-3: Patient eye care limitations on coverage; WV ST § 33-25E-4: Patient eye care required disclosure. Date enacted: 1996.
 
Insurance Policies Required to Provide Coverage Any diabetes insurance and group accident or sickness policy that provides major medical or similar comprehensive type medical coverage. Any health benefits policy that includes eye care benefits, including a diabetic retinal examination.
 
People Covered by Insurance Mandates
  • Insulin dependent diabetes
  • Non-insulin dependent diabetes
  • Gestational diabetes
 
Benefits Required
Medication:   Yes 
  1. Insulin.
  2. Pharmacological agents for controlling blood sugar.
Equipment and Supplies:  Yes 
  1. Blood glucose monitors.
  2. Monitor supplies.
  3. Injection aids, syringes.
  4. Insulin infusion devices. 
  5. Orthotics and any additional items as promulgated by rule.
Education:  Yes  Not specified.
Services:  Yes  Self-management education.
 
Copayments/Deductibles

Any deductible or coinsurance billed for any service as provided in this section shall apply equally with all other coverages provided by the insurer but not included in this section.

 
Special Features and Issues

N/A

 
Statute Web Link

http://www.legis.state.wv.us/WVCODE/ChapterEntire.cfm?chap=33&art=15C 

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: Disease Management/Patient Education Program includes diabetes under the program Medicaid Diabetes Management Program. Program administrator: West Virginia Diabetes Control Network.
 
Diabetes Prevention and Control Programs

West Virginia Diabetes Prevention & Control Program, West Virginia Department of Health & Human Resources.
http://www.wvdiabetes.org/

 

Wisconsin

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
5,601,640 3,000 37,000 105,000 56,000 55,000 259,000 5,023,000
 
State Laws and Regulations

WI ST 40.52; WI ST 632.895: Disability insurance policies. Date enacted: 2002.

 
Insurance Policies Required to Provide Coverage Every health insurance policy that covers expenses for the treatment of diabetes - including those offered by the state and the self-insured plan of the state.
 
People Covered by Insurance Mandates Patients with diabetes; Type of diabetes not specified.
 
Benefits Required
Medication:   Yes 

Not specified. 

Equipment:  Yes

Installation and use of an insulin infusion pump and other necessary equipment.

 Supplies:  Yes Not specified.
Education:  Yes Not specified.
Services:  Yes Self-management programs.
 
Copayments/Deductibles

Coverage required under this paragraph shall be subject to the same exclusions, limitations, deductibles and coinsurance provisions of the plan as other covered expenses, except that insulin infusion pump coverage may be limited to purchase of one pump per year, and the plan may require the covered person to use a pump for 30 days before purchase.

 
Special Features and Issues

N/A

 
Statute Web Link

http://www.legis.state.wi.us/2001/data/SB-250.pdf

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered Covered 
Disposable Needles:  Covered** Covered
Syringe Combinations:  Covered** Covered
Blood Glucose Strips:  Covered** Covered
  Notes: As of July 1, 1998, Medicare covers a home glucose monitor, lancets for drawing blood, reagent strips and other supplies necessary for proper use of the glucometer for all diabetics. Before July 1, 1998, these benefits were available to insulin-dependent diabetics only. Also as of July 1, 1998, Medicare provides coverage for diabetes self-management training furnished in non-hospital-based programs.**Covered as durable medical supplies.
 
Diabetes Prevention and Control Programs

Wisconsin Diabetes Prevention & Control Program, Wisconsin Department of Health Services.
http://dhs.wisconsin.gov/health/diabetes/

 

Wyoming

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
522,830 300 4,000 10,000 6,000 4,000 24,300 447,000
 
State Laws and Regulations WY ST §26-18-103: General requirements for policies; WY ST §26-19-107: Group disability and blanket insurance standard provisions; exceptions; WY ST §26-20-201: Diabetes coverage. Date enacted: 2001.
 
Insurance Policies Required to Provide Coverage All individual and group health insurance policies that provide coverage on an expense-incurred basis; individual and group service or indemnity contracts issued by any insurer including any nonprofit corporation; and individual and group service contracts issued by a health maintenance organization (HMO) that provide coverage.
 
People Covered by Insurance Mandates
  • Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin using diabetes
  • If prescribed by a health care professional legally authorized to prescribe such items under law
 
Benefits Required
Medication:   N/A

Not mentioned.

Equipment and Supplies:  Yes  Not specified.  
Education:  Yes  Medical nutrition therapy included.
Services:  Yes  Outpatient self-management training.
 
Copayments/Deductibles

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

 
Special Features and Issues

N/A

 
Statute Web Link

http://legisweb.state.wy.us/statutes/statutes.aspx?file=titles/Title26/Title26.htm 

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered Covered
  Notes: Disease Management/Patient Education Program includes diabetes. Program administrator: APS Healthcare.   
 
Diabetes Prevention and Control Programs

Wyoming Diabetes Prevention & Control Program, Wyoming Department of Health.
http://wdh.state.wy.us/PHSD/DIABETES/index.html

 

District of Columbia

  Number of Residents with Diabetes by Age Group  
State Population Age Birth to 19 Age 20 to 44 Age 45 to 64 Age 65 to 74 Age 75+ Total State Population with Diabetes Number of People Covered by Health Insurance
588,292 300 4,000 16,000 9,000 6,000 35,300 526,000
 
State Laws and Regulations DC CODE §31-3001: Definitions; DC CODE §31-3002: Payable Benefits; DC CODE §31-3003: Nondiscrimination; DC CODE §31-3004: Applicability. Date enacted: 2000.
 
Insurance Policies Required to Provide Coverage “Health benefit plan” means an accident and health insurance policy or certificate, hospital and medical services corporation contract, health maintenance organization subscriber contract, plan provided by a multiple employer welfare arrangement, or plan provided by another benefit arrangement.
 
People Covered by Insurance Mandates
  • Insulin-dependent diabetes
  • Insulin-using diabetes
  • Gestational diabetes
  • Non-insulin-using diabetes
 
Benefits Required
Medication:   N/A 

Not mentioned.

Equipment and Supplies:  Yes  Not specified.  
Education:  Yes Medical nutritional therapy included, for treatment of diabetes if prescribed by a health care professional legally authorized to prescribe such item.
Services:  Yes Outpatient self-management training.
 
Copayments/Deductibles

Not specified. 

 
Special Features and Issues

N/A 

 
Statute Web Link

http://www.michie.com/dc/lpext.dll?f=templates&fn=main-h.htm&cp=

 
Public Programs Medicaid CHIP
Prescribed Insulin:  Covered  Covered 
Disposable Needles:  Covered Covered
Syringe Combinations:  Covered Covered
Blood Glucose Strips:  Covered  Covered 
  Notes: N/A
 
Diabetes Prevention and Control Programs

DC Diabetes Prevention & Control Program, D.C. Department of Health.
Visit the website.

Puerto Rico, U.S. Virgin Islands, and Guam

Puerto Rico, the U.S. Virgin Islands and Guam have not enacted statutes regarding insurance coverage for diabetes sufferers.  Based on the Medicaid coverage information available from the Centers for Medicare and Medicaid Services and Medicaid benefits coverage compiled by the National Pharmaceutical Council, no information was available on Medicaid coverage for diabetes in these territories.

 

Territory

Population

0-19 year olds with diabetes.

18-44 year olds with diabetes

45-64 year olds with diabetes

65-74 year olds with diabetes

75+ year olds with diabetes

Total Population with Diabetes

Puerto Rico

3,942,375

2,200

42,000

155,000

74,000

56,000

330,200

U.S. Virgin Islands

109,8401

1002

1000+

3,000

1000

1000+

6100

Guam

175,8773

1004

 

 

Guam Statistics on Diabetes5

Population

0-19 year olds with diabetes

25-34 year olds with diabetes

35-44 year olds with diabetes

45-54 year olds with diabetes

Total Population with Diabetes6

Number of People with Health Insurance

175,8775

1007

2008

1,000

2,000

16,000

144,000


Policymaker Resources

Consumer Resources 

  • The National Changing Diabetes® Program (NCDP) brings together innovators in diabetes education, treatment, reimbursement and policy to shift attitudes and change the way patients and health care professionals think about diabetes. Launched in 2005, the National Changing Diabetes® Program is a plan of action - operating on multiple fronts - that aims to improve diabetes outcomes which in turn will have a positive impact on the lives of countless Americans. Our vision is to change diabetes - to improve lives by causing change in the US system of health care to dramatically advance the prevention, care and management of diabetes.

Private Sector Initiatives

  • United HealthCare Example: United HealthCare is now using health savings accounts (HSAs) and health reimbursement arrangements (HRAs) to do something innovative: aligning health incentives with economic incentives. For diabetics, the program works like this. Deductibles and copayments are reduced to zero for four classes of medications, certain supplies and some office visits. Patients are further prodded by an online tracking and reminder system. Patients who comply with their treatment regimes are rewarded with an additional contribution to their health account of up to $1,000 a year.  Details online:  http://healthaffairs.org/blog/2009/02/12/patient-power-for-chronic-illness, 2/09. 

Related Resources

End Notes and Sources

  • United States Census Bureau. United States by States and Puerto Rico  Population Estimates. 2007 Estimate http://factfinder.census.gov/servlet/GCTTable?_bm=y&-geo_id=01000US&-_box_head_nbr=GCT-T1&-ds_name=PEP_2007_EST&-_lang=en&-format=US-9&-_sse=on.  The 2007 estimate is used for all the states and territories unless otherwise noted.
  •  This figure was calculated using US Census population figures for the birth to 19 year old population.  The Centers for Disease Control estimates that 0.2% of  0-19 year olds are diabetic.(www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf).  The estimated figure here represents 0.2% of each state's 0-19 year old population.  Note as well that the 0-19 year old category overlaps with the next category covering 18 to 44 year olds for two years - 18 year olds and 19 year olds.  This overlap was a consequence of using the available diabetes data from the CDC and the population estimates available from the Census Bureau, which were used to calculate the number of diabetics between 0 and 19 years of age.  The figure is a 2007 estimate.
  • Centers for Disease Control and Prevention. CDC's Diabetes Program - Data & Trends - Diabetes Surveillance System - Prevalence of Diabetes by State - Numbers (in Thousands) with Diagnosed Diabetes, by Age and State, United States, 1994-2005. Centers for Disease Control and Prevention. www.cdc.gov/diabetes/statistics/prev/state/tNumberTotal.htm.  Note the total state population of individuals with diabetes does not always precisely equal the sum of the number of diabetics for each age range due to rounding done by the CDC in their collection of this data of adult diabetics.  This 2005 estimate from CDC is used for all the states and territories unless otherwise noted.
  • United States Census Bureau.  Health Insurance Coverage Status by State for All People: 1999 to 2007.  2007 Estimate. www.census.gov/hhes/www/hlthins/historic/hihistt4.xls
  • The National Pharmaceutical Council. Pharmaceutical Benefits Under State Medical Assistance Programs. 2007. http://www.scribd.com/doc/8417428/Pharmaceutical-Benefits-Under-State-Medical-Assistance-Programs-2007
  •  The most recent data available for individuals with diabetes in Hawaii is 2004 for all age ranges except the birth to age 19 range.  This data is presented here.  All other states have 2005 data for the age categories between 18 and 75+ unless noted otherwise. (http://www.cdc.gov/diabetes/statistics/prev/state/tNumberTotal.htm) accessed 9/10/08.
  1. CIA Fact Book Online. https://www.cia.gov/library/publications/the-world-factbook/geos/vq.html. 2008 estimate.
  2. This figure was calculated using 2000 US Census population figures for United States Virgin Islands.; www.census.gov/prod/cen2000/island/VIprofile.pdf.
  3. CIA Fact Book Online. https://www.cia.gov/library/publications/the-world-factbook/geos/gq.html. 2008 estimate.
  4. 2000 estimate. This figure was calculated using 2000 US Census population figures for Guam. (http://www.census.gov/prod/cen2000/island/VIprofile.pdf).
  5. Unless otherwise noted, the data for Guam are from the Guam Behavioral Risk Factor Surveillance System study of diabetes in Guam residents.  The results of this random sampling study have been extrapolated to the larger Guam population to estimate diabetes sufferers in all the age groups except the 0-19-year-old group.  The BRFS was used to estimate the number of Guam residents with health insurance. 
  6. This estimated figure is based on the Guam BRFS finding that 9.2 percent of the population has been diagnosed as diabetic.  This estimate does not include the approximately 2.4 percent of the Guam population that is considered either borderline diabetic or at risk of diabetes.
  7. CIA Fact Book Online. https://www.cia.gov/library/publications/the-world-factbook/geos/gq.html. 2008 estimate.
  8. This figure was calculated using 2000 U.S. Census population figures for Guam; www.census.gov/prod/cen2000/island/VIprofile.pdf

Authors:

Richard Cauchi, Program Director, authored the 1999-2008 and 2010 editions and manages NCSL work on health insurance and coverage.
Katie Mason authored the 2011 updates.
Yeasol Chung provided extensive 2008 research, writing and design for this expanded report.
Andrew Thangasamy provided additional research and editing for the 2009 edition.  

This report is a project of the NCSL Health Program, based in Denver.  It will be updated regularly to reflect new laws and state statistics.

NCSL gratefully acknowledges Novo-Nordisk for providing financial support for this project.

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