Advocate

Medicaid and Medicare Coverage for Diabetes

More than 14 million Americans living with diabetes receive access to healthcare through Medicaid and Medicare. Both programs play a major role in, and bear a huge part of the financial burden of America’s diabetes epidemic.

Medicaid is a program providing medical care for certain individuals and families with low incomes and resources.

Medicaid is a state-administered program. Each state sets its own guidelines subject to federal rules. Certain services must be covered by the states in order to receive federal funds, such as in- and outpatient hospital services, doctor visits, and long term care services, such as nursing home care or community-based care.

Additional services are optional and are elected by states. For example, coverage of prescription drugs is an optional state benefit, however, every state and the District of Columbia provides prescription drug coverage to Medicaid enrollees.

Similarly, millions of people with diabetes rely on Medicare for their diabetes supplies and services which are covered under the program. One out of every three Medicare dollars is spent on diabetes. Through Medicare, individuals at risk for diabetes can receive free preventive care screenings including up to two diabetes screenings per year, and a free annual wellness visit.

Medicaid

Medicaid is a government-sponsored health insurance program for low-income populations. Nationally, almost 3.5 million people with diabetes, including children, adults, seniors and people with disabilities, rely on the program for their healthcare needs.

As low-income individuals are disproportionately affected by diabetes, we are very concerned with proposals that would cut or reduce benefits and eligibility, as well as efforts to introduce or increase co-payments and monthly premiums.

Given that studies show lower overall cost-sharing in the Medicaid program improves medication adherence in people with diabetes, increased cost sharing, reductions in benefits, or other cuts in the program will make it very difficult for millions of children and adults who rely on the Medicaid program to successfully manage their diabetes and reduce their incidence of devastating – and costly – complications such as blindness, amputations and kidney dialysis.

While cutting care to people with diabetes may provide short-term savings, it will ultimately result in increased spending on emergency room visits, hospitalizations, treatment of serious complications and overall healthcare system expenditures.

Medicare

Medicare is a government sponsored health insurance program that provides health coverage to certain populations including: individuals aged 65 and over, individuals under 65 who are disabled, and others who meet special criteria. Not surprisingly since it serves the elderly and those with disabilities, a significant portion of the Medicare population experience a variety of serious illnesses, including chronic diseases such as diabetes.

In 2010, approximately 10.9 million people with diabetes received access to healthcare through Medicare. Because many Medicare beneficiaries, including those with diabetes, already face substantial financial burden under the program, we continue to monitor legislative and administrative proposals that affect Medicare beneficiaries with diabetes especially those that affect beneficiary cost-sharing.

We urge legislators to oppose proposals that shift costs, cut funding and/or restructure Medicaid and Medicare since these kinds of drastic changes will limit access for low-income, older and disabled Americans with diabetes and lead to a deterioration in public health.

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