Medicaid CGM Barriers in Blind/Low Vision and Deaf/Hard of Hearing Populations

Continuous glucose monitors (CGMs) are essential tools for diabetes management; however, many state Medicaid programs do not have standardized, inclusive policies that ensure equitable access to CGMs for blind/low vision (BLV) and deaf/hard of hearing (DHH) populations, driving disparities across the United States and its territories. This policy analysis examines the barriers and facilitators to Medicaid CGM coverage for BLV and DHH populations, specifically in Medicaid and non-Medicaid expansion states, and patient choice in CGM device selection. CGM barrier language existed in 9.6% of states and U.S. territories, preventing BLV and DHH populations from accessing CGM. Facilitator language was present in 5.8% of states and U.S. territories, advocating for equitable access to CGMs for BLV individuals but not DHH individuals. Given the limitations of CGM alarms, this paper also emphasizes the need for Medicaid to cover secondary devices that provide needed haptic, visual, and audible alarms as necessary accessibility tools rather than optional add-ons. These devices are integral to ensuring a safe and independent CGM use for BLV and DHH individuals. Policy changes that prioritize health equity, framing CGM access as both a usability issue and a matter of eligibility for all Medicaid beneficiaries, is crucial.