State Regulations Diabetes Coverage in State Regulated Health Insurance

Diabetes Coverage in State Regulated Health Insurance

Since 1995, ADA has worked with the American Diabetes Association (ADbA) and the American Association of Diabetes Educators (AADE) to pass legislation in the states to require that health insurance plans regulated at the state level cover diabetes education, supplies and services.  Along with licensure, this was one of the top priority issues in our state government affairs arena.  This effort has been extremely successful, as 46 states and the District of Columbia have approved such laws, with 31 of those laws specifically requiring coverage of medical nutrition therapy as part of the self-management training.

Laws to require coverage of diabetes self-management training have had a tremendous positive impact on persons living with diabetes and have allowed them to lead fuller and more productive lives through successful management of the disease.  They have provided beneficiaries with the knowledge and skills needed to perform self-care, manage crises, and make critical lifestyle changes.

These programs also save the health care system money in the long run, since small investments in prevention lead to long-term savings as the number of doctor visits and expensive medical procedures needed to treat the serious complications that may result from the disease are reduced.  According to the CDC, each $1 spent on diabetes outpatient education saves $2 to $3 in hospitalization costs.   The federal government recognizes the value of these programs as it has covered diabetes self-management training under Medicare since 1997.

However, in nearly every state, these laws are being challenged, endangering these hard-fought gains!  Nationally, business groups are organizing to overturn provisions of state law that require certain coverage to be provided, including those on diabetes.  In addition, most states are facing significant budget shortfalls, and are looking to eliminate many Medicaid benefits that are not part of the federally required package of benefits.  This could include self-management training and counseling for diabetes patients.

According to the National Conference of State Legislatures, in 2002, nine states considered legislation to exempt insurers from certain mandates, while 20 others considered small group health insurance market reform.  Legislation to roll back laws requiring state regulated health plans to offer certain coverages -- including diabetes self-management training - has been introduced in at least eight states.  In addition, several other states have introduced legislation to require studies of any new legislation that proposes to mandate certain health benefit coverages.  Still other states have seen the introduction of legislation to allow small employers to obtain, and health insurers to offer, health plans that do not contain health benefits mandated by state law, or to change the definition of who qualifies as a small employer exempt from state mandates.