The National DPP → Participating Payers
Participating Payers and Employers
This page describes payers that are covering the National Diabetes Prevention Program (National DPP) lifestyle change program. This page will be updated quarterly in January, April, July, and October. Payers include:
– Elizabeth (Cissy) Kraft, RVP Senior Clinical Officer, Anthem Blue Cross Colorado and Nevada
Participating Commercial Health Plans
The following list is based on publicly available data and may not be inclusive of all health plans that include the National DPP lifestyle change program as a covered benefit. Listed plan sponsors may not cover the program for all lines of business. By clicking any plans that are linked below you will be directed to a case study that tells the story of that plan offering the program to their members.
- Aetna (DE)
- Aetna Better Health of Kentucky
- Aetna Better Health of Texas
- AlohaCare
- AmeriHealth Caritas Partnership
- Anthem Blue Cross (CA)
- Anthem Blue Cross Blue Shield (CO)
- Anthem Blue Cross Blue Shield (KY)
- Aspire Health Plan (CA)
- Blue Cross Blue Shield of Idaho
- Blue Cross Blue Shield of Kansas City
- Blue Cross Blue Shield of Louisiana
- Blue Cross Blue Shield of Massachusetts
- Blue Cross Blue Shield of Michigan
- Blue Cross Blue Shield of Minnesota
- Blue Cross Blue Shield of Nebraska
- Blue Cross Blue Shield of North Carolina*
- Blue Cross Blue Shield of Ohio
- Blue Cross Blue Shield of Rhode Island
- Blue Cross Blue Shield of Western New York
- Blue Shield of California
- Capital District Physicians’ Health Plan
- Cigna
- Denver Health Medical Plan, Inc.
- EmblemHealth
- EMI Health
- Florida Blue
- GEHA
- Geisinger Health Plan (PA)
- Group Health Cooperative of Southern Central Wisconsin
- Hawaii Medical Assurance Association
- Hawaii Medical Service Association
- Health Net
- HealthPartners (PA)
- Highmark Blue Cross Blue Shield Delaware
- Highmark Blue Cross Blue Shield Pennsylvania
- Highmark Blue Cross Blue Shield West Virginia
- Humana
- Independent Health
- Kaiser Permanente (CA, CO, GA, HI)
- L.A. Care
- Medical Mutual of Ohio
- Molina Healthcare
- MVP Health Care
- Pacific Source
- Priority Health
- Sanford Health Plan
- San Francisco Health Service System
- SelectHealth
- SHARP Health Plan
- Tufts Health Plan
- UnitedHealthcare
- University Health Alliance (HI)
- Western Health Advantage (CA)
Resources for commercial health plans and employers about covering the National DPP lifestyle change program are available here.
To learn more about the health plans who are covering the National DPP lifestyle change program, visit the Coverage in Practice page of the Coverage Toolkit.
*Blue Cross Blue Shield of North Carolina, through community funding, offers the National DPP lifestyle change program to all eligible North Carolinians regardless of insurance status through 2023. The Eat Smart, Move More, Prevent Diabetes Program is available through distance learning, as well through select onsite providers across the state.
If there are additional health plans covering the National DPP lifestyle change program for their members that have not been included above, please let us know by filling out the Add a Payer or Employer Form at the bottom of this page.
Participating Private Employers
The following list is based on publicly available data and may not be inclusive of all private employers that cover the National DPP lifestyle change program for their employees. By clicking any employers that are linked below you will be directed to a case study that tells the story of that employer offering the program as a covered health or wellness benefit.
- 1199 Labor Management
- 3M
- Academy Mortgage Corporation
- Advocate Aurora
- American Eagle Outfitters, Inc.
- Anthem Blue Cross of California (Los Angeles, Tulare County, and San Diego)*
- Associated Regional and University Pathologists (ARUP)
- Ascension Wheaton Franciscan
- Associated Food Stores
- Baptist Health
- Bath Iron Works
- Bi-State Development
- BJC Healthcare
- Blue Cross Blue Shield of Kansas City*
- Boeing
- Bountiful Health Harvest Food Stores
- Central California Alliance for Health*
- Charleston Area Medical Center
- Chronic Disease Association
- Cigna**
- Club Wholesale
- CNH Industrial
- Colquit Regional Medical Center
- CompuAdd
- Costco (additional information here)
- Curi (formerly Medical Mutual)
- Disney
- Dow Chemical Company
- Eastman Chemical Company
- Edward-Elmhurst Hospital
- EmblemHealth*
- Emory University
- Florida Blue*
- Foster Farms
- Franciscan Health
- Gilsbar
- Health Net*
- Highmark Blue Cross Blue Shield of Pennsylvania*
- Holy Cross Health
- Intelli Wealth Group
- Intermountain Healthcare
- Iron Mountain
- Kaiser Permanente*
- Kenco
- Kroger
- Lafayette General Medical Center
- Latham and Watkins (additional information here and here)
- LLBean
- LMR Plastics, a Parkway Company
- Los Alamos National Laboratories
- Lowe’s
- Magellan Health
- Melaleuca – The Wellness Company
- Mercy Hospitals
- Nanticoke Health System
- National Life Group
- Navient
- Norton Healthcare
- Nu Skin
- Omada Health
- ONEOK
- Oneida Comprehensive Health Division
- Physician’s Mutual
- Piedmont Health
- Sanford Health Plan*
- Schwan’s Food Company
- SelectHealth*
- Sentara Healthcare
- Standard Aero
- South County Health Center
- Southern Champion
- Syracuse University
- St. Catherine Hospital (Finney County)
- ThedaCare
- Times Pharmacy
- The Wonderful Company
- Tufts Health Plan*
- United Healthcare (Rhode Island, Los Angeles, CA, and San Diego, CA)*
- University of Chicago Medicine
- University of Virginia Health System
- Unum
- Vanderbilt University
- Wakemed
- Wellmont Health System/Ballad Health
- Wells Fargo
- World Wide Technology
Visit the Coverage in Practice page for examples of how employer coverage looks in a real-life setting.
Resources for employers and commercial health plans on making the business case for coverage of the National DPP lifestyle change program can be found here.
* Denotes commercial health plans that cover the program for their employees and beneficiaries.
** Denotes commercial health plans that cover the program for their employers on a national basis. Please contact the commercial health plan for additional details.
If there are additional private employers covering the National DPP lifestyle change program for their employees that have not been included above, please let us know by filling out the Add a Payer or Employer Form at the bottom of this page.
Participating Public Employers
States with Public Employee Coverage
The states below provide coverage of the National DPP lifestyle change program to their public employees. States vary in which state employees receive coverage. For example, some states extend coverage to all active state employees, including state university employees and retired state employees, while other states only provide coverage to state employees enrolled with certain health plans (for a detailed accounting of coverage, see the map entitled “States with Public Employee Coverage Map” below). By clicking any states that are linked below you will be directed to a case study that tells the story of that state offering the program to its employees. States that offer some degree of National DPP lifestyle change program coverage include:
- New Hampshire – 2015
- New York – 2016 (for some carriers)
- North Dakota – October 2018
- Oklahoma
- Oregon – 2017
- Pennsylvania – January 2020
- Rhode Island – 2016
- Tennessee – 2018
- Texas – 2016
- Vermont – 2014
- Washington – 2016
- Wisconsin
- Wyoming – January 2020
– Beth Lundholm, Manager, State Employees Group Insurance Programs, Minnesota Management & Budget, quoted in the Case for Coverage Handout for Employers
Dates correspond to when coverage started or is anticipated to start, unless otherwise noted. In addition to the states listed above, there are ongoing demonstrations taking place in South Dakota and Utah.
States with Public Employee Coverage Map
The map below provides information on which employees receive coverage in each state that offers state employee coverage. Click on a highlighted state in the map below to learn more.
Current as of 6/1/22

Print States with Public Employee Coverage Map
Localities with Public Employee Coverage
The localities below provide coverage of the National DPP lifestyle change program to city and county public employees.
- City of Clarksville – Tennessee
- City of Houston – Texas
- City of Kingsport – Tennessee
- City of New York – New York
- City of Savannah – Georgia
- City of Wilmington – Delaware
- County of Johnson – Kansas
- County of Spartanburg – South Carolina
- Finney County Community Health Coalition – Kansas
- Finney County Government – Kansas
- Los Angeles City Employees’ Retirement System (LACERS) – California
Public Schools and Universities with Employee Coverage
The public schools, colleges, and universities below provide coverage of the National DPP lifestyle change program to their employees.
- Ball State University
- Colorado State University
- East Tennessee State University
- Metro Nashville Public Schools
- Missouri State University
- Missouri Western State University
- Salt Lake Community College
- Shelby County Schools
- Tennessee State University
- The Ohio State University
- University of Georgia
- University of Michigan (additional information here)
- University of Utah
If there are additional states or localities covering the National DPP lifestyle change program for their employees that have not been included above, please let us know by filling out the Add a Payer or Employer Form at the bottom of this page.
Additional Information About Private and Public Employer Coverage
Private and Public Employers with Coverage of the National DPP Lifestyle Change Program – Filterable Table
The table below includes all public and private employers, except states, that are listed on this Participating Payers page as providing coverage of the National DPP lifestyle change program to their employees. Additional information about states providing coverage to state employees is included in the “States with Public Employee Coverage Map.”
The table can be filtered and ordered to show specific details. To filter, select an option from the drop-down boxes at the top of the table. To clear a selected filter, click on the filter name under the drop-down options. To order ascending/descending, click on the title row of the column by which sorting is desired. There is also a search function that can be used for keyword searching in the table (e.g., searching “De” will return rows that have those letters next to each other anywhere in the row).
Participating Employers | State Headquarters | Employer Size (range) | Geographical Spread | IBIS Industry Type |
---|---|---|---|---|
1199 Labor Management | New York | 750-2,999 | Multistate | Health Care |
3M | Minnesota | 10,000-99,999 | Multistate | Manufacturing |
Academy Mortgage Corporation | Utah | 3,000-9,999 | National | Finance & Insurance |
Advocate Aurora | Wisconsin | 10,000-99,999 | Multistate | Health Care |
American Eagle Outfitters, Inc. | Pennsylvania | 10,000-99,999 | National | Retail Trade |
Anthem Blue Cross of California (Los Angeles, Tulare County, and San Diego)* | California | 10,000-99,999 | State | Finance & Insurance |
Ascension Wheaton Franciscan (Ascension Wisconsin) | Wisconsin | 10,000-99,999 | State | Health Care |
Associated Food Stores | Utah | 750-2,999 | Multistate | Retail Trade |
Associated Regional and University Pathologists (ARUP) | Wisconsin | 10,000-99,999 | Multistate | Health Care |
Baptist Health | Florida | 3,000-9,999 | State | Health Care |
Bath Iron Works | Maine | 750-2,999 | National | Manufacturing |
Bi-State Development | Missouri | 750-2,999 | State | Transportation & Warehousing |
BJC Healthcare | Missouri | 10,000-99,999 | State | Health Care |
Blue Cross Blue Shield of Kansas City* | Missouri | 750-2,999 | State | Finance & Insurance |
Blue KC | Missouri | 750-2,999 | State | Finance & Insurance |
Boeing | Delaware | 100,000+ | Multinational | Manufacturing |
Bountiful Harvest Health Food Stores | Florida | 750-2,999 | State | Retail Trade |
Carson Tahoe Health | Nevada | 750-2,999 | State | Health Care |
Central California Alliance for Health* | California | 1-749 | Local | Finance & Insurance |
Charleston Area Medical Center | West Virginia | 10,000-99,999 | Local | Health Care |
Chronic Disease Association | Washington | 1-749 | State | Health Care |
Cigna** | Connecticut | 10,000-99,999 | National | Finance & Insurance |
City of Clarksville | Tennessee | 750-2,999 | Local | Public Administration (City & County Public Employee Coverage) |
City of Houston (TX) | Texas | 10,000-99,999 | Multistate | Public Administration (City & County Public Employee Coverage) |
City of Kingsport | Tennessee | 1-749 | Local | Public Administration (City & County Public Employee Coverage) |
City of Kingston (TN) | Tennessee | 10,000-99,999 | Multistate | Public Administration (City & County Public Employee Coverage) |
City of New York | New York | 100,000+ | Local | Public Administration (City & County Public Employee Coverage) |
City of Savannah (GA) | Georgia | 750-2,999 | Local | Manufacturing |
City of Wilmington (Delaware) | Delaware | 750-2,999 | Local | Public Administration (City & County Public Employee Coverage) |
Club Wholesale | North Carolina | 1-749 | Local | Retail Trade |
CNH Industrial | Wisconsin | 10,000-99,999 | Multinational | Manufacturing |
Colquit Regional Medical Center | Georgia | 750-2,999 | State | Health Care |
CompuAdd | Arizona | 1-749 | State | Finance & Insurance |
Costco | Washington | 100,000+ | Multinational | Wholesale Trade |
County of Johnson | Kansas | 3,000-9,999 | Local | Public Administration (City & County Public Employee Coverage) |
County of Spartanburg | South Caroina | 1-749 | Local | Public Administration (City & County Public Employee Coverage) |
Curi (formerly Medical Mutual) | North Carolina | 1-749 | Multistate | Finance & Insurance |
Disney | California | 100,000+ | Multinational | Arts, Entertainment & Recreation |
Dow Chemical Company | Michigan | 10,000-99,999 | Multinational | Manufacturing |
East Tennessee State Univeristy | Tennessee | 750-2,999 | Local | Education (Colleges & Universities) |
Eastman Chemical Co. | Tennessee | 10,000-99,999 | Multinational | Manufacturing |
Edward-Elmhurst Hospital | Illinois | 3,000-9,999 | Local | Health Care |
EmblemHealth* | New York | 3,000-9,999 | State | Finance & Insurance |
Finney County Community Health Coalition | Kansas | 1-749 | Local | Health Care |
Finney County Government | Kansas | 1-749 | Local | Public Administration (City & County Public Employee Coverage) |
Florida Blue* | Florida | 3,000-9,999 | State | Finance & Insurance |
Foster Farms | California | 10,000-99,999 | National | Manufacturing |
Franciscan Health | Indiana | 10,000-99,999 | Multistate | Health Care |
Gilsbar | Louisiana | 1-749 | State | Finance & Insurance |
Harris Health System | Texas | 3,000-9,999 | Local | Health Care |
Health Net* | California | 3,000-9,999 | State | Finance & Insurance |
Highmark BCBS of Pennslyvania* | Pennsylvania | 10,000-99,999 | State | Finance & Insurance |
Holy Cross Health | Florida | 750-2,999 | State | Health Care |
Intelli Wealth Group | Florida | 750-2,999 | Local | Information |
Intermountain Healthcare | Utah | 10,000-99,999 | Multistate | Health Care |
Iron Mountain | Massachusetts | 10,000-99,999 | Multinational | Information |
Kaiser Permanente* | California | 100,000+ | Multistate | Finance & Insurance |
Kenco | Tennessee | 3,000-9,999 | National | Transportation & Warehousing |
Kroger | Ohio | 100,000+ | National | Retail Trade |
Lafayette General Medical Center | Louisiana | 3,000-9,999 | Local | Health Care |
Lathem and Watkins | California | 750-2,999 | Multinational | Professional, Scientific, & Technical Services |
LLBean | Maine | 3,000-9,999 | Multinational | Retail Trade |
LMR Plastics, a Parkway Company | Tennessee | 750-2,999 | Multinational | Manufacturing |
Los Alamos National Laboratories | New Mexico | 10,000-99,999 | State | Professional, Scientific, & Technical Services |
Los Angeles City Employees' Retirement System (LACERS) | California | 1-749 | State | Public Administration (City & County Public Employee Coverage) |
Lowe's | North Carolina | 100,000+ | Multinational | Retail Trade |
Magellan Health | Utah | 10,000-99,999 | Multistate | Health Care |
Melaleuca - The Wellness Company | Idaho | 750-2,999 | State | Retail Trade |
Mercy Hospitals | Missouri | 10,000-99,999 | Multistate | Health Care |
Metro Nashville Public Schools | Tennessee | 10,000-99,999 | Local | Education (Public Schools) |
Missouri State University | Missouri | 750-2,999 | Multinational | Education (Colleges & Universities) |
Missouri Western State University | Missouri | 1-749 | State | Education (Colleges & Universities) |
Nanticoke Health System | Delaware | 1-749 | Multistate | Health Care |
Navient Health System | Delaware | 3,000-9,999 | Multistate | Health Care |
Norton Heatlhcare (formerly Norton N Good Health Dept) | Kentucky | 10,000-99,999 | Multistate | Health Care |
Nu Skin | Utah | 750-2,999 | State | Retail Trade |
Omada Health | California | 1-749 | Multistate | Health Care |
Oneida Comprehensive Health Division | Wisconsin | 1-749 | State | Health Care |
ONEOK | Oklahoma | 750-2,999 | State | Manufacturing |
Physician’s Mutual | Nebraska | 750-2,999 | Multistate | Finance & Insurance |
Piedmont Health | Georgia | 10,000-99,999 | Multistate | Health Care |
Salt Lake Community College | Utah | 3,000-9,999 | State | Education (Colleges & Universities) |
San Francisco Health Service System | California | 100,000+ | State | Health Care |
Sanford Health Plan* | South Dakota | 10,000-99,999 | Multistate | Finance & Insurance |
Schwan Food Company | Minnesota | 10,000-99,999 | Multistate | Manufacturing |
SelectHealth* | Utah | 750-2,999 | Multistate | Finance & Insurance |
Sentara Healthcare | Virginia | 10,000-99,999 | Multistate | Health Care |
Shelby County Schools | Tennessee | 10,000-99,999 | Local | Education (Public Schools) |
South County Health Center | Rhode Island | 750-2,999 | State | Health Care |
Southern Champion | Tennessee | 1-749 | Multinational | Manufacturing |
St. Catherine Hospital (Finney County) | Kansas | 1-749 | State | Health Care |
Standard Aero | Arizona | 3,000-9,999 | Multinational | Transportation & Warehousing |
State of Tennessee | Tennessee | 10,000-99,999 | State | Public Administration (City & County Public Employee Coverage) |
Syracuse University | New York | 3,000-9,999 | State | Education (Colleges & Universities) |
Tennessee State University | Tennessee | 750-2,999 | State | Education (Colleges & Universities) |
The Ohio State University | Ohio | 3,000-9,999 | State | Education (Colleges & Universities) |
The Wonderful Company | California | 10,000-99,999 | Multinational | Retail Trade |
ThedaCare | Wisconsin | 3,000-9,999 | State | Health Care |
Times Pharmacy | Hawaii | 1-749 | Multistate | Retail Trade |
Tufts Health Plan* | Massachusetts | 750-2,999 | State | Finance & Insurance |
United Healthcare (Rhode Island, Los Angeles, CA, and San Diego, CA)* | Minnesota | 100,000+ | Multistate | Finance & Insurance |
University of Chicago Health | Illinois | 3,000-9,999 | State | Health Care |
University of Chicago Medicine | Illinois | 3,000-9,999 | State | Health Care |
University of Georgia | Georgia | 10,000-99,999 | State | Education (Colleges & Universities) |
University of Michigan | Michigan | 3,000-9,999 | Local | Education (Colleges & Universities) |
University of Nebraska Foundation | Nebraska | 1-749 | State | Education (Colleges & Universities) |
University of Utah Health | Utah | 10,000-99,999 | Multistate | Health Care |
University of Virginia Health System | Virginia | 10,000-99,999 | State | Health Care |
Unum | Tennessee | 3,000-9,999 | Multinational | Finance & Insurance |
Vanderbilt University | Tennessee | 3,000-9,999 | State | Education (Colleges & Universities) |
Wakemed | North Carolina | 3,000-9,999 | State | Health Care |
Wellmont Health System/Ballad Health | Tennessee | 10,000-99,999 | Multistate | Health Care |
Wells Fargo | Florida | 3,000-9,999 | State | Finance & Insurance |
World Wide Technology | Missouri | 3,000-9,999 | National | Professional, Scientific, & Technical Services |
*Denotes commercial health plans that cover the program for their employees and beneficiaries
** Denotes commercial health plans that cover the program for their employers on a national basis. Please contact the commercial health plan for additional details.
Visualizations of Private and Public Employers Covering of the National DPP Lifestyle Change Program
The charts below include all public and private employers, except states, that are listed on this participating payer page as providing coverage of the National DPP lifestyle change program to their employees. Additional information about states providing coverage to state employees is included in the “States with Public Employee Coverage Map”.
Employer Industries
The chart below shows the range of industries represented by the employers listed on this page. The industry types have been defined using the IBIS World Industry Classification system.
Number of Employees
The chart below categorizes private and public employers that cover the National DPP lifestyle change program by the number of employees in the organization. However, the National DPP lifestyle change program may not be available to all employees. For example, an employer could choose to pilot the program in one location and then expand coverage of the program to additional locations over time.
Geographic Operational Reach
The chart below shows the geographic reach of the private and public employers that cover the National DPP lifestyle change program for their employees. However, the National DPP lifestyle change program may not be available to all employees. For example, an employer could choose to pilot the program in one location and then expand coverage of the program to additional locations over time.
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State Medicaid Coverage
Print State Medicaid Coverage Map
Coverage Definitions
The dates below correspond to when coverage became effective, unless otherwise noted. The coverage approval date and benefit effective/implementation date are often not the same.
Medicaid State Plan (Existing): The state used the existing Medicaid State Plan to cover the National DPP lifestyle change program and claim federal Medicaid matching funds for the program. More information on Medicaid State Plans can be found here.
- Minnesota – January 2016
- Wyoming – January 2020, piloting the program through the Medicaid State Plan
State Plan Amendment (SPA) (New): The state Medicaid agency submitted a new SPA and received CMS approval to cover the National DPP lifestyle change program and claim federal Medicaid matching funds. More information on SPAs can be found here.
- California – January 2019
- Illinois – August 2021
- Missouri – September 2020
- Montana – 2012
- New Jersey – January 2020, date SPA approved
- New York – February 2020
1115 Waiver: The state used a section 1115 demonstration waiver (1115 waiver) to cover the National DPP lifestyle change program and claim federal Medicaid matching funds. More information on 1115 waivers can be found here.
* The National DPP lifestyle change program is offered as an optional service to eligible Medicaid beneficiaries through North Carolina’s Prepaid Health Plans (i.e., managed care) and is limited to Healthy Opportunities Pilot counties only.
State Medicaid Agency Decision (federal Medicaid matching funds mechanism TBD): The state Medicaid agency is planning to add or has added the National DPP lifestyle change program as a covered benefit in Medicaid through state rulemaking authority. The mechanism to claim federal Medicaid matching funds is in the process of being developed. More information about state Medicaid agency decisions can be found here.
- Colorado – November 2018, approval date
- Ohio – January 2022
State Legislative Decision The state legislature has passed legislation to include the National DPP lifestyle change program as a covered Medicaid benefit.
- Utah – July 2022
Required Statewide MCO Coverage The state Medicaid agency made a decision to require MCOs to offer the National DPP lifestyle change program to eligible members. This requirement is outlined in the state’s MCO contracts or another formal agreement. Federal funds are not claimed for the program. For more information on this type of mechanism, visit the Pennsylvania state story here.
- Delaware – June 2019
- Pennsylvania – January 2019
State-Supported MCO Pilot (may not be statewide): The state utilizes public health or other grant funds to fully or partially fund the pilot delivery of the National DPP lifestyle change program in Medicaid. For example, the state may financially support a single MCO or multiple MCOs in offering the program to a subset of its members. Examples of state public health funds used to support these types of MCO pilots can be found on the Additional Initiatives page.
- Michigan – January 2020
- Virginia – 2020
- Washington, D.C. – 2022
Voluntary MCO Offering (value-added service): One or more Medicaid managed care organizations (MCOs) in the state currently offer the National DPP lifestyle change program as a value-added benefit to its members. Value-added services are additional benefits MCOs offer to their members that are outside of the state Medicaid benefit package (i.e., these services are not covered by Medicaid nor do they qualify for federal Medicaid matching funds). More information on value-added services can be found here.
- Kentucky – July 2021
State Medicaid Coverage of the National DPP Lifestyle Change Program – Filterable Table
The table below can be filtered and ordered to show specific details. To filter, select an option from the drop-down boxes at the top of the table. To clear a selected filter, click on the filter name under the drop-down options. To order ascending/descending, click on the title row of the column by which sorting is desired. There is also a search function that can be used for keyword searching in the table (e.g., searching “2019” will return rows that have 2019 in the row).
State | Effective Date (unless otherwise noted) | Coverage Mechanism | Delivery Method | Eligibility Requirements | Total Possible Reimbursement | Number of Medicaid Beneficiaries in state (2018)* | % of Medicaid Population in Comprehensive Managed Care (2018)** | State Story Link |
---|---|---|---|---|---|---|---|---|
California | January 2019 | State Plan Amendment (SPA) (New) | In-person, online, distance learning, and combination | $536 (2-year total) | 13,140,347 | 81% | State Story |
|
Colorado | November 2018, approval date | State Medicaid Agency Decision | 1,302,808 | 9% | ||||
D.C. | 2022 | State-Supported MCO Pilot | 264,984 | 71% | ||||
Delaware | June 2019 | Required Statewide MCO Coverage | In-person and online | Medicaid members who have been referred through a physician referral or self-referral | 236,760 | 84% | ||
Illinois | August 2021 | State Plan Amendment (SPA) (New) | In person, online, and distance learning | Medicaid members between 18-64 years old, who are overweight or obese and have elevated blood glucose level or history of gestational diabetes; referral is not required | 670 | 3,110,093 | 69% | State Story |
Kentucky | July 2021 | Voluntary MCO Offering | Online (LARK, can contact live coach but mostly AI-driven) | Online questionnaire based on CDC risk screener (does not ask about A1C) | 1,385,239 | 91% | ||
Maryland | July 2019 | 1115 Waiver | In-person, online, distance learning, and combination | Medicaid beneficiaries must receive services through a HealthChoice MCO, be between 18-64 years old, be overweight or obese, and have an elevated blood glucose level OR history of gestational diabetes mellitus (GDM) | 670 | 1,401,781 | 83% | State Story |
Michigan | January 2020 | State-Supported MCO Pilot | 1000 | 4,623,834 | 51% | State Story | ||
Minnesota | January 2016 | Medicaid State Plan (Existing) | In-person (under PHE 1135 also covering distance learning delivery but they do not cover online delivery) | Medicaid beneficiaries must have a diagnosis of prediabetes by a qualified physician | 300 | 1,122,672 | 79% | State Story |
Missouri | September 2020 | State Plan Amendment (SPA) (New) | In-person, online, distance learning, and combination | Medicaid members who are 21 years of age and older who are overweight and have elevated blood glucose level. Services require a referral or prescription from a physician or other licensed practitioner | $577 (1 year plus 4 additional maintenance sessions for qualifying participants) | 971,143 | 73% | |
Montana | 2012 | State Plan Amendment (SPA) (New) | In-person and distance learning | Self-referral with physician approval before starting the program | 640 | 291,890 | 0 | State Story |
North Carolina | March 2022 | 1115 Waiver | 2,178,225 | 73% | ||||
New Jersey | January 2020, date SPA approved | State Plan Amendment (SPA) (New) | 1,668,451 | 94% | ||||
New York | February 2020 | State Plan Amendment (SPA) (New) | In-person (under PHE 1135 they are also covering distance learning and online online) | A referral must be written by a physician, physician assistant (PA), nurse practitioner, or midwife to participate in the National DPP | 554 | 6,153,799 | 74% | State Story |
Ohio | January 2022 | State Medicaid Agency Decision | In-person, online | Medicaid members eligibility should align with the National Diabetes Prevention Program requirements. Additionally, a prediabetes risk test is an acceptable eligibliity option for Ohio Medicaid members. | $920 (2-year total in-person), $1,176 (2-year total online) | 2,915,546 | 84% | |
Oregon | January 2019 | 1115 Waiver | In-person, online, distance learning, and combination | Blood test required (only for those without an overweight or obese diagnosis) | $1,196 (2-year total in-person), $1,176 (2-year total online) | 1,062,787 | 80% | State Story |
Pennsylvania | January 2019 | Required Statewide MCO Coverage | In-person, online, distance learning, and combination | Medicaid beneficiaries may need to have a referral from a physician to be eligible for the National DPP lifestyle change program. Each MCO determines whether a referral is required. | MCOs determine reimbursement rate | 2,933,965 | 80% | State Story |
Utah | July 2022 | State Legislative Decision | 275,511 | 82% | ||||
Vermont | 2012 | 1115 Waiver | 275,511 | 71% | ||||
Virginia | 2020 | State-Supported MCO Pilot | MCOs determine reimbursement rate | 1,063,122 | 82% | |||
Wyoming | January 2020, piloting the program through the Medicaid State Plan | Medicaid State Plan (Existing) | Online, distance learning, and combination | Allowing individuals under 18 years of age to participate. Participants must meet pre-diabetes criteria. Blood test required. | 418 | 58,390 | 0 |
*Source: Medicaid.gov, 2018 Managed Care Summary https://data.medicaid.gov/dataset/52ed908b-0cb8-5dd2-846d-99d4af12b369, accessed October 2021
**Medicaid Enrollment in Comprehensive Managed Care represents an unduplicated count of Medicaid beneficiaries enrolled in a managed care plan that provides comprehensive benefits (acute, primary care, specialty, and any other), as well as PACE programs. It excludes beneficiaries who are enrolled in a Financial Alignment Initiative Medicare-Medicaid Plan as their only form of managed care.
A map showing states with Medicaid managed care, and the proportion of state Medicaid beneficiaries enrolled in comprehensive managed care is available here.
If there are additional states or MCOs covering the National DPP lifestyle change program in Medicaid that have not been included above, please let us know by filling out the Add a Payer or Employer Form at the bottom of this page.
Medicare Coverage
On March 23, 2016, the Department of Health and Human Services (HHS) announced that the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT) certified that the National DPP lifestyle change program would “reduce net-Medicare spending.”
Medicare coverage of the National DPP lifestyle change program (MDPP) services began on April 1, 2018. For a summary of the final rule please go here.
Medicare Advantage (MA) plans are also required to offer the benefit to their members. CMS has released guidance for Medicare Advantage plans, including an MA Fact Sheet and document that contain Medicare Advantage-related extracts from the MDPP Calendar Year 2018 Physician Fee Schedule Final Rule.
For more information, visit the Center for Medicare and Medicaid Innovation or see CMS Medicare Diabetes Prevention Program (MDPP) Expanded Model Fact Sheet.
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