Why Doesn’t Medicaid Cover Certain Diabetic Supplies?

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Diabetes is an expensive condition to manage and it’s helpful that some supplies can be covered through Medicaid. But why doesn’t Medicaid cover other diabetic supplies? 29 million Americans have diabetes and an enormous 86 million have pre-diabetes. So the coverage of diabetic supplies in a federal health program like Medicaid has real life consequences on a daily basis for millions and millions of people.

What Supplies Does Medicaid Cover?

Part B of Medicaid sets out diabetic supplies it covers. These are blood sugar (glucose) test strips, blood sugar testing monitors, insulin, lancet devices and lancets, glucose control solutions and therapeutic shoes or inserts. Although they are covered, there may still be limitations in place on the quantity of these available or the frequency with which  you can get them. That means some important supplies won’t be covered by Part B. These include insulin, unless you are using it with an insulin pump, insulin pens, syringes, or needles and alcohol swabs or gauze.

Diabetes Care Costs Are Rocketing

Given the prevalence of the condition, it is not surprising that there are high medical costs associated with diabetes. A 2015 study by the Health Care Costs Institute suggested that the cost of diabetes in America alone, including direct medical costs as well as lost productivity, had increased from $174 billion to $245 billion in the five years prior to 2012 alone. It continues to increase. Of that $245 billion, $116 billion is directly attributable to excess medical expenditure.

Spending Cuts Have Reduced Availability

A key reason certain diabetic supplies are not available on Medicaid is a simple one of spending cuts. For example, in 2013, the state of Oregon reduced the number of free strips available through Medicaid to type 2 diabetes sufferers who are not taking insulin. They were limited to one vial of strips at the time of diagnosis. Further vials would need them to prove a medical risk, and were anyway limited in quantity. This is a typical example of how efforts to reduce the reimbursement costs associated with Medicaid have filtered down in lesser availability of key supplies through the programme for diabetes patients. If you look at what is excluded you may notice that some of the items are everyday medical supplies used for a wide range of conditions as well as diabetes, like syringes and alcohol swabs. Part of the justification for excluding these items is indeed that they are widely available and have a low cost. So, it is expected that patients would be more able to source them on their own, without financial support under the Medicaid programme. Medicaid  is often used as a benchmark against which private insurers looking to cut payout expenses can justify their own reductions in coverage. So a move like this by Medicaid may be designed to cut the costs of the federal programme, but it can often end up being mirrored in private programmes which don’t necessarily face the same or even similar financial pressures that Medicaid does.

What Lack Of Coverage Means For Patients

Medicaid is only one healthcare program. Patients who do not have relevant coverage may be able to get the supplies from other program or a private insurance scheme. However, Medicaid is designed to provide medical coverage to people who are not of great means. Often, then, they will not have the wide range of coverage options which are available to richer people. So in practice often their option for supplies excluded from Medicaid coverage will be either to pay for them themselves, or forego the supply, which will limit their ability to manage their diabetes as effectively as possible.