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:
“The availability of the evidence-based National DPP lifestyle program for practitioners, health plans, and employers allows for a comprehensive patient-centered approach to preventing the progress to type 2 diabetes for at-risk adults. This opportunity completes the full spectrum of prevention, health, and wellness and opens the door to health communities and to the possibility of the public-private partnerships.”

– 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.

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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.

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.

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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:

  • California – 2017
  • Colorado – 2013
  • Connecticut
  • Delaware – September 2017
  • Georgia – 2018
  • Hawaii – 2019
  • Indiana – 2018
  • Kentucky2014 (pilot in 2013)
  • Louisiana – 2015
  • Maine – 2015
  • Maryland – 2017
  • MinnesotaApril 2015
  • Montana
  • Nebraska – 2017/2018
  • 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
  • Washington2016
  • Wisconsin
  • Wyoming – January 2020
“As the largest employer in Minnesota, we are committed both to providing our members with quality health care programs and to controlling cost. Chronic diseases like diabetes impact our employees, our health plan, and our bottom line. Prevention is the key to helping our members remain healthy and lead productive lives, and the National Diabetes Prevention Program standard-of-care for individuals with prediabetes.”
– 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
Graph 1

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 WilmingtonDelaware
  • 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.

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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 EmployersState HeadquartersEmployer Size (range)Geographical SpreadIBIS Industry Type
1199 Labor ManagementNew York750-2,999MultistateHealth Care
3MMinnesota10,000-99,999MultistateManufacturing
Academy Mortgage CorporationUtah3,000-9,999NationalFinance & Insurance
Advocate AuroraWisconsin10,000-99,999MultistateHealth Care
American Eagle Outfitters, Inc.Pennsylvania10,000-99,999NationalRetail Trade
Anthem Blue Cross of California (Los Angeles, Tulare County, and San Diego)*California10,000-99,999StateFinance & Insurance
Ascension Wheaton Franciscan (Ascension Wisconsin)Wisconsin10,000-99,999StateHealth Care
Associated Food StoresUtah750-2,999MultistateRetail Trade
Associated Regional and University Pathologists (ARUP)Wisconsin10,000-99,999MultistateHealth Care
Baptist HealthFlorida3,000-9,999StateHealth Care
Bath Iron WorksMaine750-2,999NationalManufacturing
Bi-State DevelopmentMissouri750-2,999StateTransportation & Warehousing
BJC HealthcareMissouri10,000-99,999StateHealth Care
Blue Cross Blue Shield of Kansas City*Missouri750-2,999StateFinance & Insurance
Blue KCMissouri750-2,999StateFinance & Insurance
BoeingDelaware100,000+MultinationalManufacturing
Bountiful Harvest Health Food StoresFlorida750-2,999StateRetail Trade
Carson Tahoe HealthNevada750-2,999StateHealth Care
Central California Alliance for Health*California1-749LocalFinance & Insurance
Charleston Area Medical Center West Virginia10,000-99,999LocalHealth Care
Chronic Disease Association Washington1-749StateHealth Care
Cigna**Connecticut10,000-99,999NationalFinance & Insurance
City of ClarksvilleTennessee750-2,999LocalPublic Administration (City & County Public Employee Coverage)
City of Houston (TX)Texas10,000-99,999MultistatePublic Administration (City & County Public Employee Coverage)
City of KingsportTennessee1-749LocalPublic Administration (City & County Public Employee Coverage)
City of Kingston (TN)Tennessee10,000-99,999MultistatePublic Administration (City & County Public Employee Coverage)
City of New YorkNew York100,000+LocalPublic Administration (City & County Public Employee Coverage)
City of Savannah (GA)Georgia750-2,999LocalManufacturing
City of Wilmington (Delaware)Delaware750-2,999LocalPublic Administration (City & County Public Employee Coverage)
Club WholesaleNorth Carolina1-749LocalRetail Trade
CNH IndustrialWisconsin10,000-99,999MultinationalManufacturing
Colquit Regional Medical CenterGeorgia750-2,999StateHealth Care
CompuAddArizona1-749StateFinance & Insurance
CostcoWashington100,000+MultinationalWholesale Trade
County of JohnsonKansas3,000-9,999LocalPublic Administration (City & County Public Employee Coverage)
County of SpartanburgSouth Caroina1-749LocalPublic Administration (City & County Public Employee Coverage)
Curi (formerly Medical Mutual)North Carolina1-749MultistateFinance & Insurance
DisneyCalifornia100,000+MultinationalArts, Entertainment & Recreation
Dow Chemical CompanyMichigan10,000-99,999MultinationalManufacturing
East Tennessee State Univeristy Tennessee750-2,999LocalEducation (Colleges & Universities)
Eastman Chemical Co.Tennessee10,000-99,999MultinationalManufacturing
Edward-Elmhurst HospitalIllinois3,000-9,999LocalHealth Care
EmblemHealth*New York3,000-9,999StateFinance & Insurance
Finney County Community Health Coalition Kansas1-749LocalHealth Care
Finney County GovernmentKansas1-749LocalPublic Administration (City & County Public Employee Coverage)
Florida Blue*Florida3,000-9,999StateFinance & Insurance
Foster FarmsCalifornia10,000-99,999NationalManufacturing
Franciscan HealthIndiana10,000-99,999MultistateHealth Care
GilsbarLouisiana1-749StateFinance & Insurance
Harris Health SystemTexas3,000-9,999LocalHealth Care
Health Net*California3,000-9,999StateFinance & Insurance
Highmark BCBS of Pennslyvania*Pennsylvania10,000-99,999StateFinance & Insurance
Holy Cross HealthFlorida750-2,999StateHealth Care
Intelli Wealth GroupFlorida750-2,999LocalInformation
Intermountain HealthcareUtah10,000-99,999MultistateHealth Care
Iron Mountain Massachusetts10,000-99,999MultinationalInformation
Kaiser Permanente*California 100,000+MultistateFinance & Insurance
KencoTennessee3,000-9,999NationalTransportation & Warehousing
KrogerOhio100,000+NationalRetail Trade
Lafayette General Medical CenterLouisiana3,000-9,999LocalHealth Care
Lathem and WatkinsCalifornia750-2,999MultinationalProfessional, Scientific, & Technical Services
LLBeanMaine3,000-9,999MultinationalRetail Trade
LMR Plastics, a Parkway CompanyTennessee750-2,999MultinationalManufacturing
Los Alamos National LaboratoriesNew Mexico10,000-99,999StateProfessional, Scientific, & Technical Services
Los Angeles City Employees' Retirement System (LACERS)California1-749StatePublic Administration (City & County Public Employee Coverage)
Lowe'sNorth Carolina100,000+MultinationalRetail Trade
Magellan HealthUtah10,000-99,999MultistateHealth Care
Melaleuca - The Wellness CompanyIdaho750-2,999StateRetail Trade
Mercy HospitalsMissouri10,000-99,999MultistateHealth Care
Metro Nashville Public SchoolsTennessee10,000-99,999LocalEducation (Public Schools)
Missouri State UniversityMissouri750-2,999MultinationalEducation (Colleges & Universities)
Missouri Western State UniversityMissouri1-749StateEducation (Colleges & Universities)
Nanticoke Health SystemDelaware1-749MultistateHealth Care
Navient Health SystemDelaware3,000-9,999MultistateHealth Care
Norton Heatlhcare (formerly Norton N Good Health Dept)Kentucky10,000-99,999MultistateHealth Care
Nu SkinUtah750-2,999StateRetail Trade
Omada HealthCalifornia1-749MultistateHealth Care
Oneida Comprehensive Health DivisionWisconsin1-749StateHealth Care
ONEOKOklahoma750-2,999StateManufacturing
Physician’s MutualNebraska750-2,999MultistateFinance & Insurance
Piedmont HealthGeorgia10,000-99,999MultistateHealth Care
Salt Lake Community CollegeUtah3,000-9,999StateEducation (Colleges & Universities)
San Francisco Health Service SystemCalifornia100,000+StateHealth Care
Sanford Health Plan*South Dakota10,000-99,999MultistateFinance & Insurance
Schwan Food CompanyMinnesota10,000-99,999MultistateManufacturing
SelectHealth*Utah750-2,999MultistateFinance & Insurance
Sentara HealthcareVirginia10,000-99,999MultistateHealth Care
Shelby County SchoolsTennessee10,000-99,999LocalEducation (Public Schools)
South County Health CenterRhode Island750-2,999StateHealth Care
Southern ChampionTennessee1-749MultinationalManufacturing
St. Catherine Hospital (Finney County)Kansas1-749StateHealth Care
Standard AeroArizona3,000-9,999MultinationalTransportation & Warehousing
State of TennesseeTennessee10,000-99,999StatePublic Administration (City & County Public Employee Coverage)
Syracuse UniversityNew York3,000-9,999StateEducation (Colleges & Universities)
Tennessee State UniversityTennessee750-2,999StateEducation (Colleges & Universities)
The Ohio State UniversityOhio3,000-9,999StateEducation (Colleges & Universities)
The Wonderful CompanyCalifornia10,000-99,999MultinationalRetail Trade
ThedaCareWisconsin3,000-9,999StateHealth Care
Times PharmacyHawaii1-749MultistateRetail Trade
Tufts Health Plan*Massachusetts750-2,999StateFinance & Insurance
United Healthcare (Rhode Island, Los Angeles, CA, and San Diego, CA)*Minnesota100,000+MultistateFinance & Insurance
University of Chicago HealthIllinois3,000-9,999StateHealth Care
University of Chicago MedicineIllinois3,000-9,999StateHealth Care
University of GeorgiaGeorgia10,000-99,999StateEducation (Colleges & Universities)
University of MichiganMichigan3,000-9,999LocalEducation (Colleges & Universities)
University of Nebraska FoundationNebraska1-749StateEducation (Colleges & Universities)
University of Utah HealthUtah10,000-99,999MultistateHealth Care
University of Virginia Health SystemVirginia10,000-99,999StateHealth Care
UnumTennessee3,000-9,999MultinationalFinance & Insurance
Vanderbilt UniversityTennessee3,000-9,999StateEducation (Colleges & Universities)
WakemedNorth Carolina3,000-9,999StateHealth Care
Wellmont Health System/Ballad HealthTennessee10,000-99,999MultistateHealth Care
Wells FargoFlorida3,000-9,999StateFinance & Insurance
World Wide TechnologyMissouri3,000-9,999NationalProfessional, 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.

Industry-graph

Print Employer Industries Chart

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.

Emplr-Size-by-numb-of-employees

Print Employer Size Chart

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.

Org-Ops-Locations

Print Geographic Reach Chart


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State Medicaid Coverage

Since 2012, twenty states and Washington D.C. have achieved varying levels of Medicaid coverage of the National DPP lifestyle change program. Montana was the first state to achieve coverage. In 2015, NACDD, through CDC funding, awarded Maryland and Oregon a grant to promote Medicaid delivery models for the National DPP lifestyle change program through Medicaid managed care organizations (MCOs) and/or accountable care organizations (i.e., the Medicaid Coverage for the National DPP Demonstration Project).The Demonstration Project has served as a catalyst for further state coverage, generating significant progress in other states. States have been integrating the National DPP lifestyle change program into their Medicaid program through Medicaid State Plans, 1115 waivers, MCO pilots, and additional mechanisms. Please see the map below for the national picture of Medicaid coverage, and visit the State Stories of Medicaid Coverage page to learn more about these states. Below the map is a definition of each coverage mechanism used to cover the National DPP lifestyle change program in Medicaid.
Visit the State Stories of Medicaid Coverage page to learn about different approaches states have taken to achieve coverage.
Resources for making the case for coverage of the National DPP lifestyle change program in Medicaid are available here.

State-Medicaid-coverage-map

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.

  • MinnesotaJanuary 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.

  • CaliforniaJanuary 2019
  • IllinoisAugust 2021
  • Missouri – September 2020
  • Montana2012
  • New Jersey – January 2020, date SPA approved
  • New YorkFebruary 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.

  • MarylandJuly 2019
  • North Carolina* – March 2022
  • OregonJanuary 2019
  • Vermont – 2012

* 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.

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.

  • MichiganJanuary 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).

StateEffective Date (unless otherwise noted)Coverage MechanismDelivery MethodEligibility RequirementsTotal Possible ReimbursementNumber of Medicaid Beneficiaries in state (2018)*% of Medicaid Population in Comprehensive Managed Care (2018)**State Story Link
CaliforniaJanuary 2019State Plan Amendment (SPA) (New)In-person, online, distance learning, and combination $536 (2-year total)13,140,347
81%State Story
ColoradoNovember 2018, approval dateState Medicaid Agency Decision1,302,808
9%
D.C.2022State-Supported MCO Pilot264,984
71%
DelawareJune 2019Required Statewide MCO CoverageIn-person and online Medicaid members who have been referred through a physician referral or self-referral236,760
84%
IllinoisAugust 2021State Plan Amendment (SPA) (New)In person, online, and distance learningMedicaid 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 required6703,110,093
69%State Story
KentuckyJuly 2021Voluntary 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%
MarylandJuly 20191115 WaiverIn-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)6701,401,781
83%State Story
MichiganJanuary 2020State-Supported MCO Pilot10004,623,834
51%State Story
MinnesotaJanuary 2016Medicaid 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 physician3001,122,672
79%State Story
MissouriSeptember 2020State 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%
Montana2012State Plan Amendment (SPA) (New)In-person and distance learningSelf-referral with physician approval before starting the program640291,890
0State Story
North CarolinaMarch 20221115 Waiver2,178,225
73%
New JerseyJanuary 2020, date SPA approvedState Plan Amendment (SPA) (New)1,668,451
94%
New YorkFebruary 2020State 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 DPP5546,153,799
74%State Story
OhioJanuary 2022State Medicaid Agency DecisionIn-person, onlineMedicaid 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%
OregonJanuary 20191115 WaiverIn-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
PennsylvaniaJanuary 2019Required Statewide MCO CoverageIn-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 rate2,933,965
80%State Story
UtahJuly 2022State Legislative Decision275,511
82%
Vermont20121115 Waiver275,511
71%
Virginia2020State-Supported MCO PilotMCOs determine reimbursement rate1,063,122
82%
WyomingJanuary 2020, piloting the program through the Medicaid State PlanMedicaid State Plan (Existing)Online, distance learning, and combinationAllowing individuals under 18 years of age to participate. Participants must meet pre-diabetes criteria. Blood test required. 41858,390
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.

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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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Add a Payer or Employer

Know of a payer or employer covering the National DPP lifestyle change program not included on this page?

If you know of a payer or employer that covers the National DPP lifestyle change program and you would like them added on this page, fill out the form below.

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Content Updated: June 27, 2022

Participating Commercial Health Plans

Participating Private Employers

Participating Public Employers

Additional Information About Private and Public Employer Coverage

Employer Industries

Number of Employees

Geographic Operational Reach

State Medicaid Coverage

Medicare Coverage

Know of a payer or employer covering the National DPP lifestyle change program not included on this page?

  • Participating Commercial Health Plans
  • Participating Private Employers
  • Participating Public Employers
  • Additional Information About Private and Public Employer Coverage
  • Employer Industries
  • Number of Employees
  • Geographic Operational Reach
  • State Medicaid Coverage
  • Medicare Coverage
  • Know of a payer or employer covering the National DPP lifestyle change program not included on this page?