Does Medicaid Cover CGM 2026: State Coverage!

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2026-04-10T08:00:19+08:00

Wondering does medicaid cover cgm? Explore our state-by-state guide on Medicaid eligibility, requirements, and cost-effective alternatives like SIBIONICS!

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Many people face a critical question when first diagnosed with diabetes or adjusting their treatment plan: does medicaid cover cgm?

As a practitioner with years of research experience in continuous glucose monitoring (CGM), I often hear patients' concerns about high medical costs.

CGM technology can dramatically change how you manage diabetes, but if you cannot afford it, its value is significantly reduced.

Fortunately, US healthcare policies have seen major shifts in recent years.

Whether you are looking for insurance coverage or exploring cost-effective out-of-pocket options like SIBIONICS, this guide will break down Medicaid policies state by state to help you find the best path for glucose management.

The Short Answer: Is Your CGM Covered By Medicaid?

If you are wondering does medicaid cover cgm devices, the short answer is: yes. Today, the vast majority of state Medicaid programs offer some form of CGM coverage.

However, specific reimbursement policies and entry barriers largely depend on your state of residence and your type of diabetes.

In recent years, federal and state health departments have increasingly supported better access to CGMs.

According to official guidelines from the American Diabetes Association (ADA), CGMs can effectively improve glycemic management and reduce the risk of severe hypoglycemia for insulin-dependent patients [1].

Despite this authoritative backing, for a cgm covered by medicaid, all states share a common prerequisite - "medical necessity."

This means you need a clear prescription from your doctor and relevant medical records to prove you genuinely need this device.

Who Qualifies for Medicaid CGM Coverage?

Once you understand the basic coverage landscape, the next step is determining cgm who qualifies medicaid.

Coverage For Type 1 VS Type 2 Diabetes

Asking does medicaid cover cgm for type 2 diabetes is one of the most common questions I receive.

Historically, Medicaid typically only covered CGMs for patients with Type 1 Diabetes (T1D), as their blood sugar fluctuations are often more severe and fully insulin-dependent.

Today, T1D coverage is highly prevalent.

The good news is that coverage policies for Type 2 Diabetes (T2D) are expanding rapidly.

A study published in JAMA shows that patients with T2D using basal insulin saw significant improvements in Time in Range after using a CGM [2].

Based on such clinical data, more states are extending coverage to T2D patients requiring multiple daily insulin injections.

Clinical Criteria For Eligibility

Beyond a diabetes diagnosis, Medicaid usually requires meeting specific clinical criteria.

A common condition is hypoglycemia unawareness, meaning the body shows no obvious warning signs when blood sugar drops.

An authoritative study in The Journal of Clinical Endocrinology & Metabolism notes that CGMs offer crucial protection for patients with hypoglycemia unawareness, significantly reducing the frequency of severe low blood sugar events.

Additionally, frequent severe hypoglycemia or failing to meet glycemic targets despite multiple daily fingerstick tests can serve as strong evidence of medical necessity for Medicaid.

State-by-State Breakdown: Texas, Colorado, And Maryland

Medicaid systems in the US operate independently, so policies vary widely. Here is an analysis of a few representative states.

CGM Coverage In Texas Medicaid

When looking at cgm texas medicaid coverage, the rules are quite specific. First, applicants must have a diabetes diagnosis, whether Type 1 or Type 2.

Additionally, a healthcare provider must certify that the CGM is medically necessary for the patient's glucose management.

This provider is typically an endocrinologist or the physician managing the diabetes care, and they must document the clinical need in the patient's medical records.

The patient must also follow a treatment plan that includes regular glucose monitoring and insulin or medication management.

For patients on insulin therapy, CGM coverage is generally considered necessary.

The treatment plan must involve insulin use or a similarly intensive management strategy, and the doctor must explain the device's importance in adjusting treatment.

For non-insulin users, Texas Medicaid might still approve coverage if specific clinical conditions are met, such as frequent severe hypoglycemia, significant unexplained glucose fluctuations, or instances of ketoacidosis or hospitalization due to uncontrolled blood sugar.

Applying for coverage usually requires prior authorization. The initial request must include an in-person or approved telehealth evaluation and proof of medical necessity.

Once initial authorization is granted, ongoing coverage for supplies like sensors and transmitters requires continued proof of patient compliance and clinical necessity.

It is worth noting that only complete CGM systems (sensor, transmitter, and dedicated receiver) are covered as Durable Medical Equipment (DME).

CGMs that solely rely on a smartphone or tablet as a receiver are generally not covered.

Colorado Medicaid CGM Policies

For those asking does colorado medicaid cover cgm, Health First Colorado does provide coverage for diabetes patients, provided they meet strict medical necessity standards.

Applicants need a confirmed diagnosis and documentation from a prescribing healthcare provider stating the clinical necessity of the device.

Eligible individuals include those on insulin therapy and patients with other qualifying medical conditions requiring continuous monitoring.

Under Colorado Senate Bill 24-168, patients with gestational diabetes can also receive coverage during their pregnancy.

Both initial applications and renewals require prior authorization.

Providers must submit the patient's medical history, a statement of medical necessity, and note whether the patient has received or plans to receive diabetes education related to CGM use.

After approval, patients must adhere to their treatment plan and attend follow-up evaluations to prove compliance and ongoing clinical need.

Colorado Medicaid covers complete systems and necessary supplies, including repairs or replacement parts when medically justified.

Does Medicaid Cover CGM In Maryland?

For those looking into does medicaid cover diabetes cgm maryland, the Maryland Medical Assistance Program covers qualified individuals.

Applicants must have a diagnosis of diabetes or gestational diabetes, and a prescribing provider must evaluate their condition, confirm clinical necessity, and ensure the prescription aligns with FDA indications.

Furthermore, patients or their caregivers must complete device training and be able to properly respond to alerts to ensure safe and effective monitoring.

Patients must also meet at least one clinical criterion: current insulin treatment or a documented history of severe hypoglycemia (such as repeated readings below 54 mg/dL or at least one hypoglycemia event requiring assistance).

These rules ensure coverage is directed to those who truly need continuous monitoring.

Prior authorization is required for both new applications and renewals. Providers must submit medical history, clinical evidence, and evaluation notes.

Once approved, patients must follow their treatment plan and attend follow-ups to maintain coverage.

Maryland Medicaid covers the complete system and associated supplies, including sensors and transmitters, and covers repairs or replacements when necessary.

Medicaid CGM Coverage By State

To make searching easier, we have compiled a list of Medicaid CGM coverage across US states:

State / Region | Official CGM Coverage Available | Official Policy (or Manual/Bulletin/PDF) | Coverage Type | Coverage Criteria & Requirements
Alabama | ✔ Covered | Alabama Medicaid CGM Policy ( medicaid.alabama.gov ) | DME (PA required) | T1 or T2 + multiple insulin injections, PA required
Alaska | ✔ Covered | Alaska Medicaid PDL with CGM Category (Center for Health Care Strategies) | Pharmacy benefit | Type 1 & insulin-treated Type 2
Arizona | ✔ Covered | AHCCCS AMPM 310-P / SB 1132 | Pharmacy & DME (Provider's Choice) | Insulin-treated or Hypoglycemia; Standards aligned across all plans & channels
Arkansas | ✔ Covered | Arkansas DHS Official CGM Note (Medicaid) | DME benefit | Type 1 or insulin-treated / hypoglycemia history
California | ✔ Covered | Medi-Cal Rx Provider Manual (CGM Terms) | Pharmacy / DME (PA required) | Prescription + Medical Necessity required
Colorado | ✔ Covered | CO Medicaid DMEPOS Manual CGM § | DME/POS | Diabetes + insulin therapy documentation
Connecticut | ✔ Covered | Husky Health CGM Policy PDF | Pharmacy / DME | Medical necessity + diagnosis
Delaware | ✔ Covered | Delaware Medicaid PDL | Pharmacy | Medical prescription along with diabetes diagnosis and proof of medical necessity
D.C. | ✔ Covered | DC Medicaid Diabetic Supply Listing | Pharmacy | Diagnosis + prescription
Florida | ✔ Covered | FL Medicaid Alert (Official) | Pharmacy | Variable conditions – consult state PDL
Georgia | ✔ Covered | Georgia Code § 49‑4‑159.4 - CGM Coverage Requirement | DME | Diabetes + insulin or hypoglycemia history
Hawaii | ✔ Covered | Hawaii Revised Statutes | Pharmacy (Primary) / DME | All Diabetes types; Medically necessary & Prescribed; Repairs/Parts included in coverage
Idaho | ✔ Covered | Idaho Medicaid Provider Handbook | DME | Diagnosis + clinical necessity
Illinois | ✔ Covered | IL Medicaid Preferred Drug List | Pharmacy | Type 1 & insulin-using Type 2
Indiana | ✔ Covered | Indiana Medicaid Preferred Drug List (PDL) | Pharmacy | PA for non-preferred CGMs
Iowa | ✔ Covered | Iowa DME Clinical Criteria | DME | Clinical documentation
Kansas | ✔ Covered | Kansas Medicaid Provider Manuals | DME | T1D or T2D on insulin; Requires documentation of poor A1C control or hypoglycemia unawareness
Kentucky | ✔ Covered | KY Provider Notice 249 | Pharmacy | Type 2 / gestational / hypoglycemia history
Louisiana | ✔ Covered | Louisiana Informational Bulletin 22-23 | Pharmacy | Diabetes + insulin/hypoglycemia
Maine | ✔ Covered | Maine Preferred Diabetic Supply List | Pharmacy | Diagnosis
Maryland | ✔ Covered | Maryland Provider Transmittal No.83 | DME / Pharmacy | Diabetes diagnosis
Massachusetts | ✔ Covered | MassHealth Guidelines (CGM) (Massachusetts State Government) | DME | Medical necessity documentation
Michigan | ✔ Covered | MI Medicaid Bulletin MSA19-04 (Center for Health Care Strategies) | DME / Pharmacy | Type 1 / clinical necessity
Minnesota | ✔ Covered | MN DHS Diabetic Equipment & Supplies (Center for Health Care Strategies) | Pharmacy/DME | Diabetes diagnosis
Mississippi | ✔ Covered | MS Medicaid Diabetic Supplies Guide (Center for Health Care Strategies) | Pharmacy/DME | Clinical documentation
Missouri | ✔ Covered | MO Medicaid Diabetic Supplies | Pharmacy/DME | Clinical criteria
Montana | ✔ Covered | MT Medicaid PDL | Pharmacy/DME | Diagnosis & necessity
Nebraska | ✔ Covered | NE Medicaid PPBM / PDL Source | Pharmacy/DME | Diabetes + insulin or hypoglycemia history
Nevada | ✔ Covered | NV Medicaid PDL | Pharmacy | Diagnosis + Clinical Criteria
New Hampshire | ✔ Covered | NH Medicaid PDL | Pharmacy | Clinical documentation
New Jersey | ✔ Covered | NJ Medicaid Manuals | Pharmacy | Insulin treatment or Level 2 Hypoglycemia history
New Mexico | ✔ Covered | NM Medicaid PDL | Pharmacy | Insulin-treated (MDI) or Pregnancy or Severe Hypoglycemia history
New York | ✔ Covered | NY Medicaid CGM Update PDF | Pharmacy | Type 1, Type 2 (on Insulin), or Gestational
North Carolina | ✔ Covered | NC Medicaid CGM Clinical Policy PDF (NC Medicaid) | Pharmacy | Therapeutic CGM with PA
North Dakota | ✔ Covered | ND Medicaid Drug Coverage Manual | Pharmacy | Dexcom is sole preferred brand; Insulin-treated; PA required
Ohio | ✔ Covered | OH Medicaid Preferred Diabetic List | Pharmacy | Insulin-treated (3+ times/day) or Severe Hypoglycemia history; PA required
Oklahoma | ✔ Covered | OK Healthcare Authority CGM Page | Pharmacy (Primary) | Clinical documentation
Oregon | ✔ Covered | OR CGM Evidence Review Guidance (Center for Health Care Strategies) | Pharmacy Preferred (DME secondary) | Insulin-treated or Severe Hypoglycemia; Mandated follow-up (6-12 months)
Pennsylvania | ✔ Covered | PA DHS Pharmacy Services | Pharmacy | Insulin-dependent (3+ shots/day) AND Hypoglycemia history/Unawareness; PA required
Rhode Island | ✔ Covered | RI EOHHS (Medicaid Clinical Policy) | Pharmacy Preferred / DME | Insulin history in last 6 months; Diagnosis of T1D, T2D, or Gestational; PA required
South Carolina | ✔ Covered | SC Medicaid CGM Bulletin (2024) (South Carolina Department of Health and Human Services) | Pharmacy/DME | Type 1/T2 + hypoglycemia criteria + PA
South Dakota | ✔ Covered | SD Medicaid PDL / Manual | Pharmacy (Mandatory) / DME (only for Dual Eligible) | Type 1, T2 (on rapid/short-acting insulin), or Gestational; PA required
Tennessee | ✔ Covered | TennCare PDL / Clinical Criteria | Pharmacy | Insulin-treated (1+ daily) OR Level 2 Hypoglycemia history; PA required
Texas | ✔ Covered | Texas HHSC / TMPPM | Pharmacy/DME | Insulin-treated (MDI/Pump) or Gestational or Severe Hypoglycemia; PA required
Utah | ✔ Covered | Utah DHHS Hybrid Unified PDL | Pharmacy | Insulin-treated (3+ times/day) or Severe Hypoglycemia; PA required
Vermont | ✔ Covered | VT Medicaid PDL (Center for Health Care Strategies) | Pharmacy | Type 1, T2 (on insulin), or Gestational; Prior Authorization required (Simplified for preferred brands)
Virginia | ✔ Covered | VA Medicaid CGM Coverage Bulletin (Virginia Medicaid) | Pharmacy/DME | Insulin-treated or problematic hypoglycemia + follow-up
Washington | ✔ Covered | WA Medicaid PDL / Manual | Pharmacy | Type 1 (Auto-approve), T2 (Insulin-treated), or Gestational; PA simplified for Dexcom/Libre
West Virginia | ✔ Covered | WV Medicaid Coverage Manual | Pharmacy/DME | Insulin-treated (documented 6-month history); PA required; 90-day supply encouraged
Wisconsin | ✔ Covered | ForwardHealth Online Handbook | DME & Transitioning to Pharmacy | Any diabetes (excl. pre-diabetes); Insulin-treated or History of Level 2/3 Hypoglycemia
Wyoming | ✔ Covered | WY Medicaid PDL | Pharmacy | Intensive Insulin Therapy (3+ shots/day or Pump); Daily BGM 4+ times; PA required

Please note: State policy documents may update over time. Always refer to the latest official state government information for practical procedures.

How to Get Medicaid to Cover Your CGM: A Step-by-Step Guide

Even after understanding the policies, figuring out how to get medicaid to cover a cgm is still a process that requires patience. Here is a basic application guide:

Step 1: Consult your doctor and get a prescription

Your primary care physician or endocrinologist must write a clear CGM prescription. Mention your intent to use Medicaid so they can add the proper notes in the system.

Step 2: Prove medical necessity (blood sugar logs, medical records)

Often, a prescription alone is not enough.

You must provide detailed medical records, including past A1C results, glucose logs, and any ER records for severe low blood sugar events.

Step 3: Choose the right cgm suppliers

Medicaid usually requires you to get your device from an in-network medical equipment provider or pharmacy.

Selecting compliant cgm suppliers who know the process can help avoid paperwork errors and speed up approval.

Step 4: Determine if it falls under pharmacy or DME benefits

Billing methods vary by state.

Some states classify it as a Pharmacy Benefit, meaning you can pick it up locally, while others classify it as Durable Medical Equipment (DME) requiring shipment from a specialized medical device company.

What CGM Brands Does Medicaid Typically Cover?

Regarding what cgm does medicaid cover, most state programs include the major CGM brands currently on the market.

However, each state usually maintains its own Preferred Drug List (PDL).

If the brand your doctor prescribed is not on the preferred list, you may need a Prior Authorization (PA).

This is a lengthy process designed to explain why the preferred brand is not suitable for you.

Research shows that complex prior authorization processes and inconsistent state policies are major barriers for low-income patients trying to access CGMs [3].

Therefore, be prepared for multiple communications with insurance and potentially long waiting periods.

Out-Of-Pocket Alternatives: Is SIBIONICS Right For You?

In actual user feedback, I often hear patients complain about the lengthy insurance approval process.

Many are even denied because they do not meet strict clinical criteria, such as not using insulin.

For those facing an insurance gap or not meeting eligibility, checking the SIBIONICS CGM cost and considering a highly cost-effective, out-of-pocket option is a very practical choice.

If you opt to pay out of pocket, the SIBIONICS GS3 Continuous Glucose Monitoring System is worth your attention.

According to official data, the GS3 system weighs just 1.5g and features an IP38 advanced waterproof rating, making it perfect for worry-free wear during daily showers and workouts.

This allows you to control costs while securing 24/7 continuous glucose data, saving you the time and energy of battling with insurance companies.

Verdict: Navigating Your Path to CGM Access

Overall, Medicaid coverage for CGMs is indeed expanding year by year, which is a positive sign for diabetes patients.

However, due to differing state policies and the hurdle of proving medical necessity, the process can still be challenging.

I recommend starting by checking your eligibility on your local state's official website and actively communicating with your doctor to gather medical records.

If your insurance application stalls or the wait is too long, consider brands like SIBIONICS that offer more flexible and affordable out-of-pocket solutions, ensuring no gaps in your health management.

FAQ: Common Questions About Medicaid and CGM

Does Medicaid cover CGM sensors and transmitters?

Typically, Medicaid covers sensors and transmitters (or all-in-one systems) as a complete package.

However, due to the limited lifespan of sensors, patients usually need to request refills from their pharmacy or supplier according to their prescription cycle.

If I move, will my Medicaid CGM coverage still be valid?

Medicaid is a jointly funded federal and state program administered independently by each state. Therefore, policies do not automatically transfer across state lines.

If you move, you must reapply for Medicaid in your new state and resubmit your CGM coverage application based on their specific rules.

References

[1] American Diabetes Association Professional Practice Committee. (2024). 7. Diabetes Technology: Standards of Care in Diabetes—2024. Diabetes Care, 47(Supplement_1), S126-S144. https://doi.org/10.2337/dc24-S007
[2] Martens T, et al. (2021). Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial. JAMA, 325(22), 2262–2272. https://doi.org/10.1001/jama.2021.7444
[3] Galindo, R. J., Aleppo, G., Parkin, C. G., Baidal, D. A., Carlson, A. L., Cengiz, E., … & Umpierrez, G. E. (2024). Increase access, reduce disparities: Recommendations for modifying Medicaid CGM coverage eligibility criteria. Journal of Diabetes Science and Technology, 18(4), 974–987. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11307217/

Disclaimer

This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Author Info

This article was written by the SIBIONICS Professional Health Content Team. The author has years of research experience in CGM and diabetes management, helping users optimize their device experience through science-based practices.

Last Updated: April 10, 2026