US Diabetes Coverage Resources
Updated: April 2007; reposted May 2008
A leading cause of blindness, kidney disease, heart disease and amputations, diabetes claims the lives of more than 193,000 Americans each year. According to the CDC, it is the country’s sixth leading cause of death by disease. Approximately 21 million Americans have diabetes, but 29 percent of those are undiagnosed. This statistic is a slight improvement as reported by HHS, which had prioritized diabetes awareness and prevention and treatment since 2001.
As of January 2008, forty-six states and DC have some type of laws requiring health insurance coverage to include treatment for diabetes. Most states require coverage of both direct treatment and the costs of diabetes treatment equipment and supplies often used by the patient at home. The states not included are Alabama, Idaho, North Dakota and Ohio. The laws in three other states are limited to requiring that insurers offer coverage, but not necessarily include the coverage in all active policies- Mississippi, Missouri and Washington.
In 2002, Georgia and Wisconsin each passed an expansion of current coverage requirements. In 2003 Hawaii adopted a resolution to clarify its mandate of diabetes education coverage.
The table below includes enacted laws, all passed since the first mandate laws in California in 1981 and New York in 1993.
Economic Costs of Diabetes in the U.S. in 2007 published in Diabetes Care by the American Diabetes Association, March 2008. Their total estimated cost of diabetes in 2007 is $174 billion:
Includes $116 billion in excess medical expenditures and $58 billion in reduced national productivity.
$27 billion for care to directly treat diabetes,
$58 billion to treat the portion of diabetes-related chronic complications that are attributed to diabetes,
$31 billon in excess general medical costs.
Recent State Laws & Updates
| State | Bill or Law citation / description or comments Citations in blue are web links |
| Alaska |
Sec. 21.42.390. Coverage for treatment of diabetes. |
| Arizona | A.R.S. §20-826(P), §20-934 – 1998 law – Any contract covering diabetes must include coverage for equipment and supplies that are medically necessary. |
| Arkansas | 1997 law: HB 1797. Medically necessary supplies and services when prescribed by a licensed physician. |
| California | Section 1367.51 of the Health and Safety Code SB 64 – signed 9/27/99 – expands a 1981 law to include equipment, supplies and drugs. SB 2094 of 2000 – signed 9/30/2000 – updates coverage to include outpatient daily self-management training, education and medical nutrition therapy services. |
| Colorado | §10-16-104 (13) – 1998 law – coverage “shall include equipment, supplies, and outpatient self-management training and education, including medical nutrition therapy if prescribed by a health care provider.” |
| Connecticut | §38a-492(d) – 1997, 1999 laws – Provides medically necessary equipment, laboratory and diagnostic tests. |
| Delaware | Del. Code 18 § 3344 & 18 §3560; enacted as S. 190 of 2000 6/30/2000 – requires coverage for diabetes equipment and supplies if prescribed by a physician. [link updated 2007] |
| District ofColumbia | DC Code § 31-3002 et seq. – Law 13-175, signed 10/21/00 – requires insurers to “provide coverage for the equipment, supplies, and other outpatient self-management training and education, including medical nutritional therapy, for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and non-insulin using diabetes…” |
| Florida | § 627.6408 – 1995 law – Covers medically appropriate and necessary equipment, supplies and training for the treatment of diabetes. |
| Georgia | § 33-24-59.2 – as amended by H 1492 – 2002 law – Changes law to a mandate for coverage, effective July 1, 2002. “…shall provide coverage for medically necessary equipment, supplies, pharmacologic agents, and outpatient self-management training and education, including medical nutrition therapy, for individuals with insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and noninsulin-using diabetes who adhere to the prognosis and treatment regimen prescribed by a physician.”An earlier 1998 law required only an offer of coverage for medically necessary equipment, supplies, pharmacological agents and out-patient self-therapy prescribed by a physician |
| Hawaii | H2392 – signed 6/19/2000. Requires all individual accident and sickness health care policies and all group health care contracts issued by HMOs and mutual benefit societies to provide coverage for outpatient diabetes self-management training, education, equipment and supplies.HCR 132 of 2003. Requests that the auditor assess both the social and financial effects of requiring that the diabetes coverage for education be provided by a certified diabetes educator, a program recognized by the American Diabetes Association, or a health care professional who has completed an accredited comprehensive diabetes education review course. Did not pass chamber.
HB 2123 of 2004. Creates mandated health benefit council to advise the auditor and legislature on proposed benefits. Repeals all existing mandated benefits on 6/30/2009. Limits new mandated benefits to 5 years. Requires council to advise legislature whether to allow repeal of benefit or to renew for further 5 years. Did not pass chamber. |
| Illinois | 215 ILCS 5/365w – (H. 3427) – 1998 law |
| Indiana | §27-8-14.5 – (S. 184) – 1997 law |
| Iowa | Iowa §514C.18; enacted as S 8, enacted as Ch. 75 and Ch. 208 of 1999, signed 4/28/99, expanding a 1984 law. Provides that insurers “provide coverage benefits for the cost associated with equipment, supplies and self-management training and education for the treatment of all types of diabetes mellitus.” [link updated 2007] |
| Kansas | KS ST Sec. 40-2, 163 Coverage for certain expenses related to care and treatment of diabetes; educational expenses; exceptions. Insurers must… “provide coverage for equipment, and supplies, limited to hypodermic needles and supplies used exclusively with diabetes management and outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin using diabetes…” (Signed 1998, as ch. 174, § 28) [link updated 2007] |
| Kentucky | K.R.S. §304.17A-148 -1998 law. Requires coverage for equipment, supplies and necessary training. (link requires Adobe Reader) |
| Louisiana | §22:215.21 – 1997 law. Provides for coverage for equipment, supplies and outpatient self-management training for diabetes. Does not apply to individually underwritten policy |
| Maine | Tit 24 § 2332-F (nonprofits); 2654 (individual) and 2847-E (group) – 1996 law. Covers medically appropriate and necessary equipment, insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets, and out-patient self-management. |
| Massachusetts | S.2109, now Chapter 81 of the Acts of 2000 – law signed May 4, 2000. Requires diabetes coverage. |
| Michigan | S 260, now Chapter 424 of 2000 -Law signed 1/9/2001-the Diabetes Cost Reduction Act (DCRA), a law requiring Michigan regulated health insurance and managed care policies to cover necessary diabetes supplies and services within 90 days. |
| Minnesota | §62A.45 – 1994 law. Covers supplies, outpatient self-management training and education, including medical nutrition therapy. |
| Mississippi | §83-9-46 – 1998 law. Requires offer of coverage for equipment and supplies, including monitoring and insulin self-management |
| Missouri | 1997 law – requires offer of coverage for equipment and supplies. |
| Montana | H. 406 of 2001 – Law signed 4/30/2001. Requires group disability insurers to cover outpatient self-management training and education and the following diabetic equipment and supplies: insulin, syringes; injection aids; devices for self-monitoring of glucose levels test strips; visual reading and urine test strips; one insulin pump and accessories to insulin pumps; one prescriptive oral agent used to control blood sugar levels; and glucagon emergency kits. Coverage must include a $250 benefit per person per year. |
| Nebraska | L 99 – 1999 law. |
| Nevada | §689A.0427 (individual); §689B.0357 (group); §695C.1727 (HMOs) – 1997 law. Covers training and education for self-management, with same copayments and deductibles as other benefits. |
| New Hampshire | §415:18-f (group) – 1997 law. |
| New Jersey | §17B:26-2.1l (individual); §17B:27-46 (group) -1996 law. |
| New Mexico | §59A-46-43 (SB 682 Approved April 11, 1997)- Law requiring health care plans to provide coverage for individuals with insulin-using diabetes, with non-insulin-using diabetes, and with elevated blood glucose levels induced by pregnancy with prescribed equipment, supplies, and appliances to treat diabetes. |
| New York | Insurance §3216i (15a); Chapter 378 of 1993 law – Requires coverage of “blood glucose monitors and blood glucose monitors for the visually impaired, data management systems, test strips for glucose monitors and visual reading and urine testing strips, insulin, injection aids, cartridges for the visually impaired, syringes, insulin pumps and appurtenances thereto, insulin infusion devices, and oral agents for controlling blood sugar; also include coverage for diabetes self-management education.” |
| North Carolina | §58-51-61; (nonprofits); §58-67-74 (HMOs) – 1997 law. |
| Oklahoma | Tit. 36 §6060.1 – 1996 law. |
| Oregon | S 286 of 2001 – signed 7/4/01. Requires coverage for supplies, equipment and self-management programs. A 1987 law, ORS §743.704 covered diabetes self-management education. Part of that provision expired, but most insurers continued to provide coverage. |
| Pennsylvania | HB 656 – 1998 law. (Pa. Laws, Act 98) |
| Rhode Island | §27-18-38 (individual or group); §27-19-35 (nonprofits) – 1996 law. |
| South Carolina | S.C. code 38-71-46 enacted 5/27/99. Effective date 1/1/2000 S.494 of 2000 – signed 3/29/2000. Expands law to provide for coverage of FDA approved diabetes medication. H.4441 – signed 6/14/2000, establishes limited conditions for denials if a health care professional fails to adhere to the minimal standards of care. |
| South Dakota | H.1121 of 1999 – signed on 3/17/99. Includes coverage for nutrition therapy H. 1085 of 2000 – signed on 2/16/2000. Expands law for coverage for equipment, supplies, and self-management training and education, including medical nutrition therapy. |
| Tennessee | §56-7-2605 – 1997 law. |
| Texas | Ins. Code Chapter 1358. DIABETES [link updated 4/07] S.982 – signed 6/19/99, effective 9/1/99. It expands the original 1997 law, and includes coverage for nutrition therapy. Amended by: Acts 2003, Ch. 1274, § 3, effective April 1, 2005. |
| Utah | SB 108 of 2000 – signed 3/14/2000, effective 7/1/2000. Requires Utah Insurance Commissioner to establish minimum standards of diabetes coverage for disability insurance policies. |
| Vermont | Tit. 8 § 4089c – 1997 law. |
| Virginia | H. 1376 of 2000 – signed on 4/19/2000 – clarifies coverage for inpatient self-management, training and education; excludes coverage for durable medical equipment. S.244 (Chapter 35 of 1999) – signed on 3/4/99, effective 7/1/99. Includes coverage for nutrition therapy. This expands HB 1399 (Chapters 35 and 386 of 1998) for coverage of state employees |
| Washington | §48.44 (health benefit plans); §48.46 (HMOs) – 1997 law; requires offer of coverage for equipment and supplies. |
| West Virginia | §33-16-16 (major medical) – 1996 law. Requires health insurance policies to provide coverage for specified medically necessary equipment and supplies.; includes education in self-management diet. |
| Wisconsin | (§632.895[6]) signed 1987 and 1996 – Includes “an insulin infusion pump, coverage for all other equipment and supplies, including insulin, used in the treatment of diabetes and coverage of diabetic self-management education programs.” S.250 of 2002 – signed 4/17/02 – requires health insurance policies to also cover prescription medications used to treat diabetes. |
| Wyoming | H. 185, now Chapter 142 of 2001 – Requires insurers to provide coverage for equipment, supplies and outpatient self-management training and education, including medical nutrition therapy. Effective July 1, 2001. |
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