Expansion of Medicaid Coverage of Continuous Glucose Monitor Reduces Health Disparity

Background: Continuous glucose monitor (CGM) usage improves glycemia in people with type 1 diabetes (PWT1D) and is accepted as the standard of care. CGM utilization is lower in patients with public insurance and minorized ethnicities. In 2022, California Medicaid expanded CGM coverage to all PWT1D without requiring a minimum number of glucose tests per day. It is unknown if this policy change is sufficient to increase CGM usage. We hypothesize that Medicaid expansion narrowed but did not eliminate the disparity in CGM usage. Methods: Data was extracted from electronic medical record of a large urban children's hospital in 2021 and 2022. CGM usage was determined based on clinician documentation or the presence of CGM downloads. We limited the data query to PWT1D who were seen at least once in the diabetes clinic each year. Chi-square and student T-tests were used to determine statistical significance (P<0.05). Results: We included 1471 and 1355 PWT1D in 2021 and 2022, respectively. Medicaid insured 66.8% and 62.2% of the patients in 2021 and 2022, respectively. CGM usage increased 1.4-fold in the entire patient population (2021: 52.2%, 2022: 71.1%). Between 2021 and 2022, CGM usage increased 1.6-fold (39% to 63%) and 1.1-fold (77% to 85%) for those with Medicaid and private insurances, respectively. CGM usage increased in all race/ethnicities, with the largest increase seen in patients who identify as Black and Latino (2021 vs 2022: White 69% vs 83%, Latino 38% vs 60%, Black 15% to 50%, P≤ 0.0001 for all comparisons). CGM usage increased 1.3-fold (58% to 74%) in English speakers and 2.1-fold (29% to 59%) in non-English speakers. Conclusion: Our results demonstrate that Medicaid expansion of CGM coverage increases its utilization for pediatric PWT1D. Despite increased CGM usage in marginalized community, disparity persists among patients with public insurance, minority races/ethnicities, and non-English language. Future studies are needed to identify barriers that preclude equity in technology uptake. Disclosure B. Miyazaki: None. T. Zeier: None. R. O. Barber: None. J. C. Espinoza: Consultant; Sanofi, Research Support; NIH - National Institutes of Health, FDA, Speaker's Bureau; Glooko, Inc. L. C. Chao: None. Funding U.S. Food and Drug Administration (P50FD006425 to J.C.E.)