Medicaid coverage of continuous glucose monitors in Texas: A quality improvement success story in advocacy
Background/Objective: The aim of our quality improvement (QI) advocacy project was to obtain continuous glucose monitoring (CGM) coverage for pediatric patients with Texas Medicaid as this was not a covered benefit.
Methods: A diabetes flowsheet within our electronic medical record system allowed our team to identify a difference in rates of CGM use between our clinicʼs public and privately insured patients with type 1 diabetes (T1D). At the local level, a CGM submission process for high-risk T1D patients with Texas Childrenʼs Health Plan (a health maintenance organization for Texas Medicaid) coverage was modified through several PDSA cycles to increase approvals and support the use of CGM in this cohort. At the state level, a CGM evidence-based practice summary was created and submitted to Texas Medicaid as part of a topic nomination application to support CGM as a covered benefit. Multiple letters in support of CGM coverage were sent by clinicians, diabetes care team members, patients and families.
Results: Following our QI Team-led advocacy efforts, Texas Medicaid approved CGM as a benefit for pediatric patients on 1 April 2020. CGM use in our clinic’s T1D population rose to greater than 60% from a baseline of 8% in 2014.
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