New Jersey health officials eager to improve public health are looking to expand Medicaid to cover preventative programs to reduce the rate of diabetes, which impacts nearly a million patients and leads to some 2,000 deaths here a year.
State leaders plan to enable healthcare providers and other groups to bill Medicaid to help pay for a nationally approved diabetes prevention program designed to help those who are on the cusp avoid the chronic blood-sugar disease. If approved by federal officials, and through the state’s upcoming budget process, New Jersey would become one of only a handful of states with this benefit when it is scheduled to take effect in July.
Leaders at the state’s YMCAs, who worked for years to be allowed to tap into this insurance coverage for low-income residents, are concerned they may be left on the sidelines. If the goal is to make the program as accessible as possible, excluding them from this potential funding source doesn’t make sense, they said.
Although a half-dozen Garden State YMCAs now offer the nationally approved program — funded through grants, fees, and other sources — a recent legal notice on the proposed change appears it would limit Medicaid reimbursements to licensed healthcare providers. The course, which targets risk factors like poor nutrition, obesity, and inactivity, has reached nearly 500 residents to date.
Officials at the Department of Human Services, which oversees Medicaid, or NJ Family Care, said they intend to include the YMCAs, assuming their programs meet the federal Centers for Disease Control and Prevention diabetes prevention program guidelines.
“We are pleased that the governor’s budget proposes expanding Medicaid coverage of diabetes self-management education and training, medical nutrition therapy, the National Diabetes Prevention Program, and supplies and equipment to the Medicaid program,” said Sarah Adelman, a deputy commissioner for DHS.
Murphy covers costs
Gov. Phil Murphy included a total of $7.3 million, including $2 million in state funds, to cover the cost of the expanded program, which — after several years of attempts — was signed into law last summer by former Gov. Chris Christie.
“These services and programs will be designed to better prevent, treat, and manage diabetes — one of the leading chronic diseases in our state. The Department is eager to work with providers, including YMCAs, to help expand these valuable benefits to individuals served by NJ Family Care,” Adelman added.
In fact, the federal Medicare program is also slated to add a diabetes prevention benefit to its plan in July. Diabetes effects one in four Americans over age 65 and cost the national insurance program for seniors an extra $42 billion in 2016 alone, according to the Centers for Medicare and Medicaid Services.
Estimates suggest that as many as 700,000 Garden State residents have been diagnosed with type 2 diabetes, a disease in which the body struggles to process blood sugar, and can increase the risk for heart disease, cause damage to the nerves, eyes and kidneys, and lead to skin and wound problems. Another 200,000 are diabetic, but not diagnosed. The incidence is much higher among individuals of color, with black residents impacted at nearly twice the rate of the community overall.
According to the CDC program, Medicaid recipients are diagnosed at a higher rate than the population at large, and are more likely to be hospitalized with complications. Once admitted, the treatments involved end up costing nearly three times as much as the average diabetes patient, due to a greater likelihood of poor health or complications.
The CDC’s National Diabetes Prevention Program is focused on members of a far larger group, those who are pre-diabetic or have high sugar levels, but have not yet developed the full-blown disease. According to the CDC, these individuals can cut their risk of diabetes by nearly 60 percent by participating in a certified prevention program.
Access is key
The key is access to the program, according to Darrin Anderson, executive director of the NJ YMCA’s State Alliance, and that means meeting people in their community. Local YMCAs have multiple locations and can also host a prevention program at a library or senior center, if that’s what makes sense for the community.
“Access is very important,” Anderson said. “We can bring it to a location where those nearby who don’t have access to transportation can still attend,” he said.
This goal also reflects a growing trend among public health leaders seeking to address the underlying social determinants of health, including poverty, poor housing, and lack of healthy food. The Trenton YMCA has worked with other stakeholders in the Trenton Health Team to reduce obesity among children in the capital city, an effort that could reduce the incidence of diabetes in the area.
Donna Peart, director of healthy living at the Fanwood-Scotch Plains YMCA, which has run the diabetes prevention program for three years, says the process can be highly effective — if the individual involved is “in the ready phase.” If people are only there because someone else urged them to go, they won’t have the same results.
The class involves more than two-dozen one-hour sessions, spread over a year, and starts with weekly meetings of a group of eight to 10 participants, Peart said. Trained leaders help those involved asses their weight and target a percentage of those pounds for loss, discuss eating habits, and find ways to include 150 minutes of exercise a week, through walking, dancing, gardening, or other activities they enjoy. In Fanwood-Scotch Plains, the program comes with a free three-month membership, and sometimes participants chose to work out together before their group class, she added.
“It’s hard work,” Peart said. “People have to be present, willing, and able,” she said, “but I tell them, “this is your one hour, just for yourself.”