While state diabetes mandates vary greatly, state laws often require coverage for:
- Diabetes-related equipment and supplies, such as blood glucose monitors, visual reading and urine strips, insulin syringes or insulin pumps.
- Diabetes services, such as diabetes self-management training.
- Diabetes medication, such as insulin.
- Diabetes education, such as medical nutritional therapy.
- Prosthetic or artificial limbs.
For specifics on state diabetes mandates, see here for NCSL’s 2016 report “State Insurance and Medicaid Coverage Requirements and Programs.”
Federal Mandates and EHB Benchmark Plans
The ACA includes various provisions affecting coverage requirements for individuals with diabetes. For example, all health insurance plans (including employer-sponsored plans) must provide coverage for certain preventive services without imposing cost-sharing on health plans enrollees. This includes screening patients for abnormal blood glucose levels and type 2 diabetes.
Additionally, health insurance plans sold in the ACA’s individual and small group marketplace must provide coverage for the 10 essential health benefits (EHBs) without annual or lifetime limits. Each state sets standards for EHB coverage through their benchmark plan, so coverage requirements for specific services and treatments (e.g., diabetes-related services) vary state-to-state. Additionally, state EHB benchmark plans must meet coverage requirements for diabetes-related services and supplies established through state-level insurance mandates.
States may include coverage requirements specific to diabetes in their EHB benchmark plans. For example:
- Alabama covers blood glucose regulators and disease management services for diabetes.
- New York covers diabetic equipment, supplies and self-management education if recommended or prescribed by a physician or other authorized health provider.
- Tennessee covers diabetes education, nutritional counseling for diabetes treatment and blood glucose regulators.
- Virginia covers medical supplies, equipment and education for diabetes care for all diabetics. This includes insulin pumps, home blood glucose monitors and outpatient self-management training and education.
The Centers for Medicare and Medicaid Services (CMS) maintains a list of EHB benchmark plans for all 50 states and the District of Columbia.