Medicaid and Medicare Coverage for Diabetes

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Medicaid

The Association continues to oppose federal cuts to Medicaid that would result in the weakening or elimination of coverage of diabetes supplies and services for those who depend on Medicaid to properly manage their condition. Inadequate access to necessary tools leads to poor disease management, which in turn results in a dramatic rise in the risk of diabetes-related complications such as blindness, kidney failure, and amputations. These complications will place an even more costly burden on the entire health care system.

The Association strongly supports support of S. 755, the "Diabetes Screening and Medicaid Savings Act" which would combat diabetes through prevention, early detection and management services in the Medicaid program. The legislation, introduced by Sens. Schumer (D-NY) and Domenici (R-NM) provides a comprehensive diabetes benefit under Medicaid for the first time. S. 755 combats the costly complications associated with diabetes by providing screening tests under the Medicaid program for adult enrollees who meet specific diabetes risk factor criteria. It provides that states offer a comprehensive package of benefits needed to adequately manage diabetes care (including prescription drug coverage, durable medical equipment, services related to pregnancy, vision care, podiatric services, education and self-management training and nutrition services). These components are crucial to lowering the overall burden and cost on our health care system. At the same time passage of this legislation will create a healthier, more productive society.

Medicare

ADA continues to monitor legislative and administrative proposals that affect Medicare beneficiaries with diabetes. This includes policy affecting:

Part D

Since the Medicare Modernization Act (MMA) went into effect in January 2006, the Association has closely followed implementation of the new prescription drug benefit offered under Medicare Part D. Many bills have also been introduced in the Senate and House of Representatives that seek statutory change to varying aspects of MMA. The Association continues to monitor such legislation.

• Centers for Medicare & Medicaid Services (CMS)

Prevention Benefits 

The Association is committed to improving the quality of life for America's seniors and people with disabilities. Under the Medicare and Modernization Act, millions of people with Medicare will be able to live longer and healthier lives through utilization of new preventative services that became effective January 1, 2005.

All people newly enrolled in Medicare Part B will be covered for an initial “Welcome to Medicare” physical examination. The exam includes:

• Measurement of height, weight, and blood pressure;
• An electrocardiogram; and
• Education, counseling, and referrals related to other preventive benefits covered by Medicare, such as screenings and disease prevention services.

This exam is only available within the first 6 months of joining Medicare. If you, or someone you know has recently enrolled please contact your doctor to schedule a Welcome to Medicare Visit.

In January 2005, Medicare also started covering prevention services tests to check for diabetes. The screening is critical because the earlier a person is diagnosed and treated for diabetes, the more likely it is that the serious health consequences of this disease can be prevented or delays. Please visit their site for screenings and more information.

The American Diabetes Association joined an effort – The Medicare Diabetes Screening Project:  A National Drive to Find the Undiagnosed – with other provider, patient, and industry groups to ensure that new Medicare diabetes screening benefits are being utilized by seniors at risk of diabetes.

Additional Resources on Prevention

• A list of Medicare’s covered services related to diabetes. (PDF)
• To learn more about prevention please visit the National Diabetes Education Program.