IDPH, IDHFS Partner to Expand Medicaid Coverage for Diabetes Programs

By Benjamin Cox on August 4, 2021 at 10:15am

Credit: Getty Images/iStockphoto

The Illinois Department of Public Health and the Illinois Department of Healthcare and Family Services announced announced yesterday that Medicaid coverage is expanding for key diabetes programs.

CDC-recognized Diabetes Prevention Programs can enroll as Illinois Medicaid providers to deliver the program to eligible participants by administering services during regular sessions over the course of the year, including dietary and nutritional counseling, fitness assessments and educational sessions on how to prevent Type 2 diabetes.

To be eligible to enroll in the DPP program, individuals must be aged 18 to 64, be enrolled in the Illinois Medicaid program, have a Body Mass Index (BMI) that exceeds a certain level and either have elevated blood-glucose levels or a history of gestational diabetes mellitus. Enrollees who were previously diagnosed with Type 1 or Type 2 diabetes or who are currently pregnant are not eligible to participate in the program.

Health care providers and Illinois Medicaid Managed Care Organizations (MCO) are able to refer participants to the program, but a referral is not required to participate. Eligible enrollees can directly enroll with a fee-for-service or an MCO’s in-network, CDC-recognized DPP provider by supplying blood test results from within the past year indicating a diagnosis of pre-diabetes or gestational diabetes mellitus.

The second program, Diabetes Self-Management Education and Support (DSMES) provides services to prevent the progression of diabetes and promoting a healthier lifestyle.

DSMES must be recommended by a medical provider or a practitioner licensed to work with individuals to halt the progression of diabetes. Services may include counseling on long-term dietary changes and nutrition, increased physical activities, skills for diabetes self-care and behavioral strategies for weight control. Services can be offered via telehealth, in-home or in a health clinic or outpatient facility.

In order to be eligible for DSMES, individuals must be aged 18 to 64 and have a documented diagnosis based on certain criteria of Type 1, Type 2, or gestational diabetes. Participants must also receive a written referral from a qualified provider, which could be a physician, physician assistant, nurse practitioner or advanced practice nurse.

Participants are eligible to receive up to 18 hours of services during a 12-month period.

HFS and IDPH are collaborating with the Illinois Public Health Institute, with support from federal partners the CDC and the National Association of Chronic Disease Directors, on a Medicaid State Plan Amendment to add coverage for these two programs. The expansion is pending a final approval from the federal government.