Medicaid's Diabetes Care and Prevention Benefits

Mary Ann HodorowiczBy Mary Ann Hodorowicz RD, LDN, MBA, CDE, CEC

Medicaid, also called Medical Assistance, is a joint federal and state government program that helps pay medical costs for some people with limited income and resources.  Each state's Medicaid insurance program is different in terms of patient income eligibility and benefits, but typically the programs pay for medical services for children and their caretakers/parents, pregnant women, and persons with disabilities that preclude work, blind people, and some elderly (over 65 years of age).  Some people who are elderly or who have a disability qualify for both Medicaid and Medicare.

For each state's Medicaid program to receive federal funds, Medicaid must pay for select services. These include in- and outpatient hospital services, doctor visits, and long-term care services.  Additional optional services can be elected by the individual states.  For example, coverage of prescription drugs is an optional state benefit; currently every state and the District of Columbia provides prescription drug coverage to Medicaid enrollees.  As an example, here is a list of diabetes-related benefits in one state's Medicaid program:

  • Test Strips and Lancets
  • Physician Visits 
  • Clinic Visits 
  • Blood Glucose Monitors 
  • Pneumococcal Vaccine 
  • Syringes, Needles, Alcohol Wipes, Cotton Swabs
  • External Infusion Pumps 
  • Prescription and Non-Prescription Drugs 
  • Therapeutic Shoes
  • Insulin and Insulin Pens 
  • Foot Exams 
  • Hemoglobin A1C and Other Blood Tests
  • Home Health Visits
  • Influenza Vaccine 
  • Wound Care Supplies 
  • Orthotic and Prosthetic Devices 
  • Smoking Cessation Programs
  • Optometry and Ophthalmology Services 
  • Personal Care Visits
  • Home Dialysis Services, Supplies and Equipment 

In 2014, a specific expansion of the federal Patient Protection and Affordable Care Act (ACA) takes effect.  These new provisions expand Medicaid coverage to millions of low-income Americans and make numerous improvements in covered benefits, including diabetes benefits.  Adults and children in families with incomes up to 133 percent of the poverty level (about $15,000 for an individual and $31,000 for a family of four in 2012 in most states) will be eligible for health insurance through their state's Medicaid program.  So if a person was previously determined ineligible for Medicaid, he/she may want to consider reapplying in 2014. To apply, contact your local Medicaid office (look in the blue pages of your phone book for contact information, probably under "Medical Assistance").  Some states let you apply over the Internet, by telephone, or at locations in the community, such as community health centers.  Although this Medicaid and Children's Health Insurance Program expansion is optional in each state, it is expected that most state's will implement the expanded eligibility and coverage.  Due to this expansion, people with diabetes and prediabetes will see: increases in coverage for diabetes services; lower out-of-pocket costs; and more choices in the type of coverage desired and the premium dollar amount that is affordable…all presented in clear and understandable language on the Internet.

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Last Modified Date: January 14, 2014

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