Medi-Cal expands patient access to diabetes supplies

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June Voros rose from her couch when a high-pitched beep alerted her that she needed a quick dose of sugar.

His blood sugar was dropping, and the continuous glucose monitor attached to his stomach beeped. The small but powerful device alerts Voros when his blood sugar is dangerously high or low.

“My blood sugar is at 64. It’s very low and still going down,” Voros, 32, said on a bright October afternoon. He checks the monitor up to 80 times a day to help prevent complications from type 1 diabetes.

But the monitor means little that makes it work, consisting of a receiver, a sensor and a transmitter – some of which must be replaced every 10 to 30 days. Voros also has an insulin pump, which provides a steady supply of that hormone to his body, and it also needs supplies.

Until recently, Voros — who is covered by Medi-Cal, California’s Medicaid program for low-income or disabled people — spent countless hours on the phone with her endocrinologist, her Medi-Cal insurer Health Net and a medical supply company to get a different one. Approval for each item. At times, his approval expires too quickly, running out of supplies and forcing him to ration and solicit donations from other diabetics on social media.

Last year, he got enough supplies for the last six months.

“I’ve spent hundreds of hours on the phone over the last few years, and I’ve changed my insurance group twice because of it,” Voros said before sipping apple juice in his studio apartment in the Mission Hills neighborhood, a suburban neighborhood in the San Fernando Valley. “It’s exhausting. It makes you want to give up. But I can’t. I’m literally going to die.”

Since October, Medi-Cal has begun relaxing prior authorization requirements that have caused life-threatening delays for Voros and others with diabetes.

Previously, drug and supply authorizations lasted six months, although for some patients, such as Voros, they expired sooner. Under the new rules, approvals are supposed to last one year from the date of approval and can include all necessary supplies — ending the scramble to secure separate approvals for each piece of equipment. Patients can get 90 days worth of supplies and medicines at a time.

The state is also formalizing a policy that allows patients to get authorization from their health care providers via phone or video.

“Before, California’s requirements were four pages long, and now they’re a little more than one page,” said Lisa Murdock, chief advocacy officer for the American Diabetes Association, who helped push the changes. “That’s a really important step. It means not having to constantly guess how the blood sugar is doing.”

In the past two years, the state has begun making continuous glucose monitors and related supplies available to many more people, including those with type 1 diabetes, a chronic autoimmune disease that attacks the insulin-producing cells of the pancreas, and type 2. Diabetes, gestational diabetes, and hypoglycemia, or chronic low blood sugar. Before last year, the monitors were only available to some patients on a case-by-case basis, according to the state Department of Health Care Services, which administers Medi-Cal.

The extended coverage extends to newer, more advanced devices, such as the popular Dexcom G7 and its components, which retail for about $700 on Amazon for a 30-day supply without insurance. Medi-Cal pays roughly $400 for the same equipment.

Diabetes and prediabetes are on the rise in California. About 3.2 million Californians have been diagnosed with diabetes. The Department of Health Care Services says about 1.2 million Medi-Cal enrollees have the disease, according to the latest available data.

Before the change, Medi-Cal recipients had a harder time securing drugs and supplies than those with private insurance, Murdock said.

“Diabetes is a really heartbreaking and expensive disease, and to take care of yourself, people with diabetes need easy access to insulin, but also supplies to manage the disease,” he said.

Patient advocates and state health officials say the changes will save money and lives by giving diabetics more control over their blood sugar and preventing complications such as organ failure and amputations of feet and toes.

This expansion of coverage “improves access and member outcomes, reduces hospitalizations and comorbidities, and improves quality of life for members with better disease management and fewer finger sticks,” said Anne Carroll, a Medi-Cal spokeswoman. He said the state wants to ensure that all diabetics receive “the care they need to lead healthy, fulfilling lives.”

Before Voros got his monitor nearly three years ago, he had to go to an emergency room For recurrent seizures and was admitted to the hospital Other diabetic complications. He also lost nerve function in his stomach — which prevents him from digesting high-fiber foods like vegetables — as his disease progressed.

“I haven’t had to go to the intensive care unit in about two years. It literally saved my life,” he said.

But the bureaucratic hurdles that prevented Voros from getting supplies for his monitors were a constant source of stress. That’s changing since he switched to a new medical supply company and Medi-Cal debuted its new pre-authorization process, amid a sweeping overhaul of its pharmacy system.

Getting his supplies on time means peace of mind, Voros said.

“I was afraid to sleep at night because of the seizures due to low blood sugar,” she said. “I was really close to death, but now I feel better than ever.”

This article is part ofThe face of Medi-Cal,” the California HealthLine series explores the impact of the state’s safety-net health program on enrollees.

This article is produced by KFF Health Newswhich reveals California HealthlineAn editorially independent service California Health Care Foundation.

Kaiser Health NewsReprinted from this article khn.orgA national newsroom that produces in-depth journalism about health issues and is one of KFF’s core operating programs – the independent source for health policy research, polling and journalism.

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