Christine Jordan Sexton
Finger pricks and blood glucose test strips could be a distant memory for as many as 43,000 Medicaid-eligible adults with diabetes under bills making their way through the Legislature this Session.
That’s because those patients would have access to continuous glucose monitors (CGMs) instead. The monitors eliminate the need for diabetics to draw blood with a lancet to test their blood sugar levels. CGMs work through a tiny sensor inserted under the skin, usually via a small plastic disk or pod adhered to the abdomen or the back of the upper arm.
A transmitter within the sensor wirelessly sends the information to a monitor, which can be a dedicated device or, in some cases, an app on a smartphone. Some CGMs can send the information in real time to a second person’s smartphone, such as a parent or caregiver. CGMs also can send alarms when a patient’s blood sugar runs too low or too high.
Members of the House Health and Human Services Committee on Monday unanimously approved HB 967 by Rep. Melony Bell. The bill heads to the House floor next. Its identical Senate counterpart (SB 988) by Sen. Colleen Burton has cleared two Senate committees and is waiting to be heard in the Senate Fiscal Policy Committee. The bills are identical.
HB 967 requires Medicaid to provide qualifying patients who have been diagnosed with Type 1 or Type 2 diabetes, or any other type of diabetes that may be treated with insulin, the ability to have a continuous glucose monitor if their provider writes a prescription.
Patients would be required to follow up with their physicians at least once every six months during the first 18 months and once every year thereafter.
The cost of the mandate varies depending on how many Medicaid beneficiaries take advantage of the benefit.
There were 43,924 adults who required diabetic supplies in the state Fiscal Year 2021-22, according to a staff analysis of the bill. If 5% of the eligible population prescribed a CGM, it could cost $13.1 million, of which $5.3 million would be covered by the state. If 50% of the eligible population were prescribed a CGM, it would cost $131.5 million, of which $53.2 million would be covered by the state.
Those costs would be offset in part by a reduction in state spending on other diabetic supplies. In state Fiscal Year 2021-22, Medicaid spent nearly $40 million on diabetic supplies, about half of which was spent on glucose testing strips.
The costs would be further reduced by decreased hospitalizations and improved health outcomes, said Committee Chair Randy Fine.
“I told you in the beginning if it makes dollars, it makes sense. So you’re proposing something that — while it sounds like it will costs money — what we’re proposing to do is to actually use technology to reduce costs down the line because people are able to measure this in real time as opposed to poking themselves every once in a while. It just makes common sense that the benefits would be better,” he said.
There has been no public opposition to the bill.
The measure would require that the costs of the CGM be taken into consideration in the Medicaid managed care rate-setting process. The bill also makes clear the mandate would be implemented subject to the availability of funds and subject to “any limitations or directions provided in the General Appropriations Act.”
Florida Medicaid currently covers CGMs for children, defined as those under 21. Some managed care plans may offer adults access to CGMs, but they are not required to and the state doesn’t reimburse for the service.
