The National DPP → Participating Payers

Participating Payers and Employers

1. Participating Commercial Health Plans
2. Participating Private Employers
3. Participating Public Employers
4. State Medicaid Coverage
5. Medicare Coverage

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.

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.

* Denotes commercial health plans that cover the program for their employees and beneficiaries

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:

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.

Print States with Public Employee Coverage Map

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).

*Denotes commercial health plans that cover the program for their employees and beneficiaries

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.

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.

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.

Print Geographic Reach Chart

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.

• Idaho
• 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
• Missouri – August 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.

• Maryland – July 2019
• Oregon – January 2019
• Vermont – 2012

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

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.

• Pennsylvania – January 2019
• Delaware – June 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 include CDC Program 1815 or CDC Program 1817 funding.

• Michigan – January 2020
• Illinois – September 2020

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.

• Illinois – September 2020
• Virginia – 2020

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).

*Source: Medicaid.gov, 2018 Managed Care Summary https://data.medicaid.gov/Enrollment/2018-Managed-Care-Enrollment-Summary/gn4b-7d7q/data, accessed January 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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Know of a payer or employer covering the National DPP lifestyle change program not included on this page?

We keep the most up-to-date information possible on payers that cover the National DPP lifestyle change program, but the lists on this page may not be comprehensive. If you know of a payer or employer that covers the National DPP lifestyle change program and you would like to include on this page, fill out the form below. The information you submit will be then reviewed for website placement. Thank you for contributing!

Content last updated: January 26, 2021