Providing Diabetes Health Coverage: State Laws & Programs - Diabetes Laws and Policy

Providing Diabetes Health Coverage: State Laws & Programs

Published: January 13, 2009

Nearly 24 million people in the United States have diabetes, equal to 7.8 percent of the total population. According to the Centers for Disease Control and Prevention (CDC) this represents an increase of more than 3 million people in approximately two years. The CDC data report released in June 2008 confirmed that diabetes is the largest and fastest-growing chronic disease in the nation.

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 is the country's sixth leading cause of death by disease.

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 December 2008, 46 states and the District of Columbia have some law requires health insurance policy coverage for diabetes treatment. 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. Laws in Mississippi, Missouri and Washington require only that insurers offer coverage, but not necessarily include the coverage in all active policies.

Some Diabetes Staistics

On May 7, 2008 the National Changing Diabetes Program released the findings of a Gallup survey assessing the public’s knowledge, perceptions and behaviors regarding diabetes. Some findings include:

Awareness that diabetes is high (94%), but low understanding of proactive action.
24 percent have been diagnosed as having diabetes (9%) or as being at-risk (24%).
47 percent of adults feel they could be at risk for diabetes, though they are not diagnosed
96 percent of Americans feel that this serious social problemto rivals AIDS, cancer and heart disease.

What this Report Covers

All state law diabetes mandates and minimum coverage requirements for state-regulated health insurance policies.
All state Medicaid diabetes coverage terms and conditions.
State sponsored Diabetes Prevention & Control Programs

The tables include the enacted state laws passed since the first California mandates in 1981 and New York's in 1993.

State Requirements for Coverage
Laws in 45 states and the District of Columbia require private market health insurance coverage 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.

Medicare covers the most diabetics and is the leading provider of diabetic supplies. Medicare Part B provides for diabetic testing suppiies to those qualified. Medicare Part D provides for prescription drugs, including insulin and syringes.

Medicaid provides coverage for low-income people and those who have few resources. Since Medicaid is jointly funded by the federal and state governments, coverage varies among states. To receive 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.

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