Medicaid Agencies → Medicaid Coverage

 

Medicaid Coverage

Services provided by the National Diabetes Prevention Program (National DPP) lifestyle change program can be covered by Medicaid if the appropriate authorities or mechanisms are in place. These include: (1) the Medicaid State plan; (2) 1115 demonstration waivers; or (3) other Medicaid managed care waivers or mechanisms (click here for a map to see if your state uses Medicaid managed care). This section provides information on these authorities and mechanisms. A major goal of the CDC funded and NACDD managed Medicaid Coverage for the National DPP Demonstration Project was to prepare the way for states to continue and expand coverage of the National DPP lifestyle change program as a Medicaid covered benefit. To see which states are offering the National DPP lifestyle change program as a Medicaid covered benefit click here.

 

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Most services provided by the National DPP lifestyle change program are qualified preventive services and therefore eligible for federal Medicaid matching funds. To draw down these funds, Medicaid agencies may need to effect coverage of the National DPP lifestyle change program through a Medicaid State Plan Amendment.

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This section provides information on how the National DPP lifestyle change program can be included in an 1115 waiver, state examples, and basic information about 1115 waivers and the process for implementation.

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A few states are considering using a 2703 Medicaid Health Home State Plan Amendment (SPA) to promote Medicaid reimbursement for the National DPP lifestyle change program. This section provides information on how the National DPP lifestyle change program can be included 2703 SPAs, state examples, and basic information about 2703 SPAs and the process for implementation.

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States have several options to cover the National DPP lifestyle change program in a managed care environment. This section provides information on these options, which include incorporating the program into Medicaid managed care performance improvement projects, value-added services, 1915(b)(3) waivers, and/or utilizing Medicaid’s alternative services mechanism.

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State Medicaid agencies must decide who will deliver the National DPP lifestyle change program to Medicaid beneficiaries. States have two options: they can use an existing provider type to deliver the program or they can create a new provider type.

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Learn how these states moved forward with Medicaid coverage of the National DPP lifestyle change program, and unique features of how the program was implemented.