Medicaid Info for Insulin-Dependent Diabetics

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Overview

Because Medicaid is run by the states, eligibility and benefits vary from state to state.  In particular, since 2014, most states significantly expanded Medicaid, opening the program to many more people, but some states haven't. (Click on the map for details.). 

Eligibility

To check if you are eligible for Medicaid, visit HealthCare.gov.


Or contact your state's Medicaid office.

Medicaid Coverage of Insulin, Insulin Pumps & Continuous Glucose Monitors & Supplies

If you do qualify for Medicaid, then Medicaid will likely cover your insulin, insulin pump and supplies, with just a prescription and/or letter of medical necessity from your provider.    


To get a CGM covered by medicaid, many states also require that patients meet a list of criteria.  For example, here is Vermont Medicaid's published list of criteria for covering a CGM.


We are creating a state-by-state list of the criteria, but in the meantime, you may be able to find your state's criteria by Googling "(your state) cgm Medicaid."  And if you already are got a pump and/or cgm covered by Medicaid, please let us know about your experience and the details by clicking here or scrolling to the form at the bottom of this page.

Let the Companies Do the Legwork

Often, the easiest way to find out if Medicaid will cover a certain insulin pump and/or CGM is to contact the pump or CGM company.  Most of the pump and CGM companies have online forms on their websites that patients can fill out to start the process of getting their pump and/or cgm.


Once you submit the form, the company (or in some cases a distributor)  will contact your doctor and insurance company to get all the documents necessary and try to get your pump and/or CGM approved.    Since doctor's offices and clinics may not quickly send in all the documents needed, you can keep the process rolling by staying in touch with the pump/cgm company and, when needed, call your doctor's office when needed to give them a little nudge.


Filling in the form to have the pump or cgm company start this process creates no commitment on the part of the patient.  So, it's a great idea to fill this in for your preferred pump and/or cgm in order to get the ball rolling.

For More Information

To find out details about your state's eligibility, coverage of diabetes equipment and supplies (like pumps and cgms), visit your state's Medicaid website.

State-by-State Medicaid Pump & CGM Coverage (Coming Soon!)

Alabama

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Alabama

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Arizona

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Arkansas

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California

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Colorado

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Connecticut

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Delaware

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Florida

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Georgia

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Hawaii

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Idaho

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Illinois

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Indiana

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Iowa

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Kansas

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Kentucky

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Louisiana

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Maine

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Maryland

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Massachusetts

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Michigan

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Minnesota

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Mississippi

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Missouri

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Montana

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Nebraska

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Nevada

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New Hampshire

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New Jersey

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New Mexico

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New York

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North Carolina

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North Dakota

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Ohio

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Oklahoma

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Oregon

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Pennsylvania

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Rhode Island

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South Carolina

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South Dakota

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Tennessee

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Texas

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Utah

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Vermont

Medicaid Expansion State


VT Medicaid Covers:
Insulin (of course)
Insulin Pumps
CGM's
Supplies


Note: CGM's require pre-approval, which is based on the following criteria: 

http://dvha.vermont.gov/for-providers/continuousglucosemonitoring-011117.pdf

(These criteria appear complicated, but most Type 1 Diabetics qualify.)


Better Living Now, a distributor in NY, handles Dexcom and Tandem orders for VT Medicaid patients. 

Virginia

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Washington

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West Virginia

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Wisconsin

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Wyoming

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Submit Your State's Medicaid Info Here!

If you prefer, you can also email us at info@cheapinsulin.org

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