Medicaid coverage for Freestyle Libre varies by state and individual circumstances. In some states, Medicaid programs provide coverage for the Freestyle Libre system, including sensors and readers. Coverage may be limited to people with certain medical conditions, such as type 1 diabetes, and may require prior authorization from the state Medicaid agency. Additionally, coverage may be affected by factors such as income, family size, and disability status. To determine if Medicaid will cover Freestyle Libre, individuals should contact their state Medicaid agency or consult with their healthcare provider.
Eligibility Criteria for Medicaid Coverage
To qualify for Medicaid coverage for the Freestyle Libre system, individuals must meet certain eligibility criteria. These criteria may vary from state to state, but generally include the following:
- Age: Individuals must be under the age of 21 or over the age of 65.
- Income: Individuals must have an income that falls below a certain level. The income limit varies from state to state, but it is typically around 138% of the federal poverty level.
- Disability: Individuals who are blind, disabled, or have a disability that prevents them from working may also be eligible for Medicaid coverage.
- Pregnancy: Pregnant women may also be eligible for Medicaid coverage.
- Children: Children from families with low incomes may also be eligible for Medicaid coverage.
In addition to these general eligibility criteria, some states may have additional requirements for Medicaid coverage of the Freestyle Libre system. For example, some states may require individuals to have a prescription from a doctor in order to be eligible for coverage.
To determine if you are eligible for Medicaid coverage of the Freestyle Libre system, you should contact your state’s Medicaid office. You can find more information about Medicaid eligibility on the website of the Centers for Medicare & Medicaid Services (CMS).
Additional Resources
- Medicaid.gov
- Medicare and Medicaid Coordination Office: Resources for Dual-Eligible Beneficiaries
- Medicaid Eligibility and Enrollment
| Family Size | Income Limit |
|---|---|
| 1 | $17,655 |
| 2 | $23,790 |
| 3 | $29,925 |
| 4 | $36,060 |
| 5 | $42,195 |
| 6 | $48,330 |
| 7 | $54,465 |
| 8 | $60,600 |
Variations in Coverage across States
Medicaid coverage for Freestyle Libre varies widely across states. Some states provide comprehensive coverage, while others offer limited coverage or no coverage at all. The table below provides an overview of Medicaid coverage for Freestyle Libre in each state:
| State | Coverage |
|---|---|
| Alabama | No coverage |
| Alaska | Limited coverage |
| Arizona | Comprehensive coverage |
| Arkansas | Limited coverage |
| California | Comprehensive coverage |
| Colorado | Comprehensive coverage |
| Connecticut | Comprehensive coverage |
| Delaware | Comprehensive coverage |
| Florida | Limited coverage |
| Georgia | No coverage |
| Hawaii | Comprehensive coverage |
| Idaho | Limited coverage |
| Illinois | Comprehensive coverage |
| Indiana | Limited coverage |
| Iowa | Limited coverage |
| Kansas | Limited coverage |
| Kentucky | Limited coverage |
| Louisiana | No coverage |
| Maine | Comprehensive coverage |
| Maryland | Comprehensive coverage |
| Massachusetts | Comprehensive coverage |
| Michigan | Comprehensive coverage |
| Minnesota | Comprehensive coverage |
| Mississippi | Limited coverage |
| Missouri | Limited coverage |
| Montana | Limited coverage |
| Nebraska | Limited coverage |
| Nevada | Limited coverage |
| New Hampshire | Comprehensive coverage |
| New Jersey | Comprehensive coverage |
| New Mexico | No coverage |
| New York | Comprehensive coverage |
| North Carolina | Limited coverage |
| North Dakota | No coverage |
| Ohio | Limited coverage |
| Oklahoma | Limited coverage |
| Oregon | Comprehensive coverage |
| Pennsylvania | Comprehensive coverage |
| Rhode Island | Comprehensive coverage |
| South Carolina | Limited coverage |
| South Dakota | No coverage |
| Tennessee | Limited coverage |
| Texas | Limited coverage |
| Utah | Limited coverage |
| Vermont | Comprehensive coverage |
| Virginia | Limited coverage |
| Washington | Comprehensive coverage |
| West Virginia | Limited coverage |
| Wisconsin | Comprehensive coverage |
| Wyoming | No coverage |
- States with Comprehensive Coverage: These states cover the full cost of Freestyle Libre for Medicaid beneficiaries who meet certain criteria. This typically includes children and adults with type 1 diabetes.
- States with Limited Coverage: These states cover a portion of the cost of Freestyle Libre for Medicaid beneficiaries. The amount of coverage varies from state to state. In some states, coverage may be limited to certain types of Freestyle Libre sensors or transmitters.
- States with No Coverage: These states do not cover Freestyle Libre for Medicaid beneficiaries. This means that Medicaid beneficiaries in these states will have to pay the full cost of Freestyle Libre out of pocket.
The coverage for Freestyle Libre under Medicaid is subject to change. It is important to check with your state’s Medicaid agency to get the most up-to-date information on coverage.
Documentation Requirements for Coverage
There are three levels of Freestyle Libre coverage under Medicaid. Here are the documentation requirements for each level:
Level 1: Continuous Glucose Monitors (CGMs) are not provided.
Level 2: High blood sugar test results from finger sticks and glucose meter readings over 3 months.
Level 3: Level 2 requirements, plus medical documentation of inability to effectively self-monitor blood sugar levels by finger stick, such as:
- Limited manual dexterity.
- Impaired vision.
- Cognitive impairment.
- Mental health conditions that interfere with BG monitoring.
- Skin irritation or allergies that make frequent finger sticks difficult.
- Hemoglobin A1c of 8% or higher.
- History of complications associated with diabetes.
Here’s a documentation summary table that includes the Acceptable Coverage Levels:
Documentation Acceptable Coverage Levels High blood glucose test results from finger sticks and glucose meter readings over 3 months. Level 2 Level 2 requirements, plus medical documentation of inability to effectively self-monitor blood sugar levels by finger stick. Level 3 Thanks so much for taking the time to read about Medicaid coverage for the Freestyle Libre. I know this can be a confusing topic, so I appreciate you sticking with me through all the details. If you have any other questions, please feel free to reach out to us directly. In the meantime, keep checking back for more updates on this and other important topics!