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. The managers of this website make every attempt to keep the information in this listing up to date. However, this information is provided with the understanding that it is not guaranteed to be correct or complete and conclusions drawn from this information are the responsibility of the user. This page will be updated quarterly in January, April, July, and October. If you have information or coverage updates for any payers, please let us know by filling out the Add or Update a Payer or Employer Form at the bottom of this page.

Payers include:

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.

*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.

**Express Scripts is a Pharmacy Benefit Manager (PBM) that provides coverage of the National DPP lifestyle change program through their SafeguardRxSM platform. They provide coverage for the program to their patients similarly to how payers provide the program to members.

If there are additional health plans covering the National DPP lifestyle change program for their members that have not been included above, or if you have coverage updates for any health plans included above, please let us know by filling out the Add or Update 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.

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, or if you have coverage updates for any employers included above, please let us know by filling out the Add or Update 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 Connecticut 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, or if you have coverage updates for any states or localities included above, please let us know by filling out the Add or Update 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
 
** 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”.

State Medicaid Coverage

Print State Medicaid Coverage Map

Print State Medicaid Coverage Timeline

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
• South Dakota – 2019
• 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.

• Maryland – July 2019
• North Carolina* – March 2022
• Oregon – January 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.

• 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

State-Supported Value-Based Care 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. For example, the state may financially support a single accountable care organization (ACO) or multiple ACOs in offering the program to a subset of its members. For more information on value-based care and ACOs, visit the Engaging ACOs page.

• Rhode Island – 2021

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
• North Dakota – January 2022

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, 2020 Managed Care Summary; Data.Medicaid.gov
**Source: Kaiser Family Foundation, Total Medicaid MCO Enrollment, Timeframe: 2020

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, or if you have coverage updates for any states or MCOs included above, please let us know by filling out the Add or Update 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? Does a payer or employer need to be deleted from this page?