California Approves Diabetes Prevention as a Covered Medicaid Benefit

Submission Date: August 2017

State/Territory Submitted on the Behalf of: California

States/Territories Involved: California

Domain Addressed:

Community-Clinical Linkages

Public Health Issue:

• More than 13 million California adults—nearly half of the state’s adult population—are estimated to have prediabetes. In a little over a decade (2001-2012), diabetes in California increased 35 percent.
• California’s Medicaid program, Medi-Cal, provides health care coverage to approximately one√¢‚ǨÔøΩthird of the state’s population. These members, who are some of the state’s most vulnerable citizens, are at the greatest risk for diabetes and diabetes complications.
• Most U.S. Medicaid program dollars are spent treating preventable or controllable chronic diseases, including diabetes. Yet, there are proven programs that can prevent type 2 diabetes and its complications.
• The strongest evidence for preventing or delaying type 2 diabetes comes from the National Diabetes Prevention Program. This CDC-recognized lifestyle change program helps persons with prediabetes achieve weight loss and exercise goals, which can reduce diabetes risk by up to 58 percent and up to 70 percent for people age 60 and older.
• The U.S. Preventive Services Task Force, an independent panel of national experts, recommends routine? screening for abnormal blood glucose and type 2 diabetes. The task force further recommends that patients found to be at risk for or experiencing diabetes should be referred to intensive behavior counseling interventions, such as CDC-recognized lifestyle change programs.

Program Action:

• The National Association of Chronic Disease Directors coordinates a national effort to increase insurance coverage for CDC-recognized diabetes prevention programs in Medicaid, Medicare, and employee health benefit plans.
• In 2015, the Association collaborated with the California Department of Public Health to host a stakeholder engagement meeting aimed at sustaining and scaling the National Diabetes Prevention Program. Attendees at this meeting included CalPERS, the agency that manages health benefits for California public employees, among other key stakeholders.
• In 2016, California HealthCare Foundation and The California Endowment funded a local nonprofit, Public Health Advocates, the UCLA Center for Health Policy Research, and CDC to produce a report estimating the prevalence of prediabetes in California by city, county, and legislative district. The report used data from the California Health Interview Survey, which is conducted by UCLA in collaboration with the California Department of Public Health and the Department of Health Care Services.
• In late 2016, CalPERS announced their intention to offer the CDC-recognized National Diabetes Prevention Program at no cost for all eligible CalPERS members. Read the NACDD success story about this action.
• Also in 2016, Public Health Advocates sponsored legislation seeking budgeted Medi-Cal funding for diabetes prevention.

Impact/Accomplishments:

• Governor Brown signed SB 97 in July 2017, making the CDC National Diabetes Prevention Program lifestyle change programs a covered service under Medi-Cal beginning in July 2018.
• As a result, California has become the third state to provide the program as a Medicaid benefit, after Montana and Minnesota.
• The state will invest $5 million to pay for enrollment in CDC-recognized programs for Medi-Cal beneficiaries who meet certain criteria, including specific weight and blood sugar measurements. This likely will be matched by $8 million from the federal government.
• Medi-Cal expects enrollment to reach about 25,000 Californians annually.
• According to Public Health Advocates, implementing this program and its interventions may save as much as $45 million per year in preventable medical treatment costs for Medi-Cal members.

Program Areas:

Diabetes

State Contact Information:

CA
Flojaune G. Cofer, PhD, MPH
Public Health Advocates
844-962-5900 x230
FC@phadvocates.org

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