Type 2 diabetes is among the most prevalent and costly chronic conditions covered by Medicaid, affecting a significant share of the low-income adults who rely on the program for coverage and care.
Most states deliver Medicaid benefits through comprehensive, risk-based managed care, contracting with managed care organizations (MCOs) to coordinate and provide services for enrolled beneficiaries. State Medicaid agencies set program requirements and payment requirements, while MCOs administer covered benefits within those parameters. Many MCOs are owned by larger parent companies—including both for-profit and nonprofit entities—that operate across multiple states.
We developed a series of state profiles to provide a structured, comparable overview of how comprehensive Medicaid managed care programs address type 2 diabetes. The profiles focus on programs using this model to serve adults without disabilities; we do not include programs serving only children or individuals with disabilities. Each profile covers five areas: the structure and history of the state’s managed care program; enrollment size and indicators of diabetes burden among Medicaid beneficiaries; covered benefits and diabetes-specific services; quality measures and MCO performance incentives; and state-level diabetes initiatives outside of Medicaid managed care.
In addition to synthesizing publicly available information, the profiles include original analyses of diabetes prevalence and medication use among Medicaid managed care enrollees with type 2 diabetes—data not previously available in a standardized, cross-state format.
COLLABORATION
This project is a collaboration among Georgetown University, the Urban Institute, and the University of Central Florida. Georgetown University and the Urban Institute jointly developed the state profiles, which are published by the Urban Institute.
ABOUT THE DATA
Data in these profiles are drawn from multiple sources and vary in coverage year by data point. The year of the data source is shown in parentheses for each category. Primary sources include the Centers for Medicare and Medicaid Services Managed Care State Profiles and State Program Features (2021), the Centers for Medicare and Medicaid Services Medicaid Managed Care Enrollment and Program Characteristics report (2022), the Center for Health Care Strategies “Continuous Glucose Monitor Access for Medicaid Beneficiaries Living with Diabetes: State-By-State Coverage” (2023), KFF State Health Facts and the KFF Medicaid Waiver Tracker (2021–26), Garfield and colleagues’ “States’ Use of Medicaid Managed Care ‘In Lieu of Services’ Authority to Address Poor Nutrition” (2025), the Orbis Database (2021), and the Centers for Medicare and Medicaid Services Managed Care Program Annual Reports (MCPARs; 2023). Original analyses of T-MSIS data conducted by Maria Alva and colleagues as part of this project provide estimates of diabetes diagnosis prevalence and diabetes medication utilization. View our full list of sources (PDF).
Program start dates are the authors' best estimate based on the available data. Benefits data reflect whether a service is available to adults without disabilities in any form; scope and generosity of coverage vary across states. Some benefits may be delivered through fee-for-service or a separate managed care arrangement rather than through the primary managed care organization (MCO). For the National Diabetes Prevention Program, we code states as not covered if they only offer the program as a pilot, as a voluntary plan offering, or at plan discretion. For continuous glucose monitoring, coverage reflects availability specifically to enrollees with type 2 diabetes.
Diabetes diagnosis prevalence reflects diagnosed prevalence among adults ages 21–64 with at least 24 consecutive months of Medicaid enrollment, and should not be interpreted as population-level disease burden. Data meeting quality thresholds were available for 11 of 38 profiled states; values for remaining states are shown as "unavailable." Data cover 2016–21; 2021 is the most recent year of the analysis.
Diabetes medication utilization reflects receipt of at least one outpatient prescription fill per drug class per year among adults ages 18 and older with type 2 diabetes and at least 24 consecutive months of Medicaid enrollment. Data cover 2016–23; 2023 is the most recent year of the analysis.
Quality measures data reflect measures included in state MCO reporting requirements as documented in 2023 MCPARs. We selected measures for their direct relevance to type 2 diabetes care. Some states require MCO reporting through contracts or external quality review processes not captured in MCPARs, which may result in undercounting for some states.
Corporate ownership and profit status data are available for 13 of 38 profiled states; data for remaining states are shown as "unavailable." Postpregnancy diabetes screening data are from a 2021 KFF survey; nonresponding states are coded as not covering this benefit.
State and community initiatives were identified through researcher web searches conducted in May 2026 and reflect programs identifiable at the time of data collection; this is not a comprehensive inventory.
PROJECT CREDITS
This tool was developed as part of a research project funded by the National Institutes of Health (grant 5R01MD017071). We are grateful to the National Institutes of Health and to all our funders, who make it possible for Urban to advance its mission. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Funders do not determine research findings or the insights and recommendations of our experts.
AUTHORS Brigette Courtot, Alaisha Verdeflor, Margaret Haughney (Georgetown University), Maria Alva (Georgetown University), Michelle Magee (Georgetown University), and Boon Peng Ng (University of Central Florida)
RESEARCH SUPPORT Emily Cheigh (Georgetown University), Katie Humphrey (Georgetown University), Alessandra Wade (Georgetown University), and Carol (Jiale) Zhou (Georgetown University)
DESIGN Brittney Spinner
DEVELOPMENT Mitchell Thorson
EDITING Lauren Lastowka and Rachel Kenney
PRODUCTION Samantha Cressman
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