1. Coverage Parameters, Threats and Treatment Opportunities
Cynthia Muñoz, Ph.D., MPH
Assistant Professor of Clinical Pediatrics,
USC Keck School of Medicine
Licensed Psychologist,
Children's Hospital Los Angeles, USC UCEDD & Endocrinology

2. What is Diabetes?
Diabetes is a disease that occurs when your blood glucose is too high.
Blood glucose is your main source of energy. Insulin, made by the pancreas, helps glucose from food get into your cells to be used for energy.
Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

3. Three Main Types of Diabetes
Gestational

4. How is Diabetes Treated?
Primarily self-managed requiring:
Physician/health care team partnership
Management plan with individualized glycemic targets Diabetes self-management education
Medications
Blood glucose monitoring and other equipment
Nutrition therapy
Psychosocial support
Regular lab work/office visits

5. Why Manage Diabetes?
Diabetes is the 7th leading cause of death in the U.S. and a leading cause of:
Heart disease and stroke
Blindness and other eye problems
Kidney disease
Amputations

6. Why Focus on Diabetes?
30.3 million people of all ages—or 9.4% of the U.S. population-- has diabetes
33.9% of U.S. adults aged 18 years or older (84.1 million people) has prediabetes
Average medical expenditures for people with diagnosed diabetes was about $13,700 in About $7,900 of this amount was attributed to diabetes
Annual total cost of diagnosed diabetes is $245 billion

7. Having Access to Adequate Health Care is Critical for People with Diabetes to Remain Healthy

8. State Health Care Laws for Diabetes
46 states have coverage laws that require coverage for diabetes supplies and equipment, education, nutrition therapy, and medications
These laws vary so even with these gaps remain
Some of the laws include Medicaid, some do not

10. Threats to these Coverage Laws
Attempts to Skirt the Coverage Laws
Interstate sale laws
Repeal attempts

11. Insurance Barriers
People with diabetes denied coverage or charged exorbitant premiums
Insurance often did not cover necessary diabetes treatment
People with diabetes effectively “locked in” to employer coverage
Patchwork of state laws provided some patient protections but uneven across country

12. Impact of ACA on People with Diabetes
Changed health insurance landscape for people with diabetes by requiring numerous consumer protections, providing financial support, and expanding coverage options to improve access to adequate and affordable coverage
Today a diagnosis of diabetes is no longer a lawful reason to deny health care

13. ACA Protections for People with Diabetes
Medicaid Expansion
Financial help for low/moderate income Americans to buy health insurance
Essential Health Benefits
Coverage on parent’s plans until age of 26
Consumer protections, including:
Guaranteed issue and renewability- People with diabetes can’t be denied coverage
People with diabetes can’t be charged higher premiums due to their diabetes
Can’t exclude coverage for preexisting conditions, including diabetes
Many free preventive services, including diabetes screening for adults and pregnant women
Nondiscrimination requirements
Closes Medicare Part D coverage gap (donut hole) by 2020

14. Medicaid Expansion
Adults with diabetes are disproportionately covered by Medicaid.
For low income individuals with diabetes and prediabetes, access to Medicaid coverage is essential to managing their health.
As a result of inconsistent access to Medicaid across the nation, these low income populations experience great disparities in access to care and health status, which is reflected in geographic, race and ethnic differences in morbidity and mortality from preventable and treatable conditions.
Medicaid expansion made available through the Affordable Care Act (ACA) offers promise of significantly reducing these disparities. Specifically, in Medicaid expansion states, more individuals are being screened for and diagnosed with diabetes than in states that haven’t expanded.
Unfortunately, since Medicaid expansion is optional for states, many low-income individuals in states that haven’t extended eligibility are left without an affordable health care coverage option.
Kaiser Commission on Medicaid and the Uninsured, The Role of Medicaid for People with Diabetes, November Available at
Kaufman H., Chen Z., Fonseca V. and McPhaul M., “Surge in Newly Identified Diabetes Among Medicaid Patients in 2014 Within Medicaid Expansion States Under the Affordable Care Act,” Diabetes Care, March 2015,

15. Improved Access for Low-Income Population with Diabetes and Prediabetes
Source: Kaufman H, et al. Surge in Newly Identified Diabetes Among Medicaid Patients in 2014 within Medicaid Expansion States Under the Affordable Care Act. Diabetes Care. Published online March 22, 2015

16. Improved Outcomes for Low-Income Population
Source: Sommers B, et al. Three-Year Impacts of The Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults. Health Affairs. 2017;36(6).

17. Medicaid Coverage Adequacy
Some benefits critical to people with diabetes and prediabetes are not covered in all states.
Diabetes Self-Management Education
National Diabetes Prevention Program
Medical Nutrition Therapy
American Diabetes Association, Standards of Medical Care in Diabetes – 2017, Diabetes Care, Jan
Diabetes Prevention Program Research Group, 10-Year Follow-Up of Diabetes Incidence and Weight Loss in the Diabetes Prevention Program Outcomes Study, Lancet, November Available at

18. Supporting Access to Care
Transparency and Enrollment Support
Language Barriers
Culturally Appropriate Information
Enrollment Assistance
Consumer Friendly Tools

19. Questions?