Oregon enacts Medicaid coverage for continuous glucose monitors starting January 2026

Oregon's House Bill 2955, introduced on January 17, 2025, aims to enhance diabetes management for Medicaid recipients by mandating coverage for continuous glucose monitors (CGMs). This legislation is particularly significant as it addresses the needs of individuals diagnosed with diabetes who are either insulin-dependent or have a history of severe hypoglycemia.

The bill outlines that Medicaid will cover CGMs for eligible recipients, provided they have a prescription from a licensed healthcare provider and attend regular follow-up appointments to assess the device's effectiveness. Specifically, patients must see their healthcare provider at least once every six months for the first 18 months after receiving the monitor, and annually thereafter. This structured approach not only ensures proper usage but also promotes ongoing medical oversight.

The urgency of the bill is underscored by its emergency declaration, which allows for immediate implementation upon passage. The Oregon Health Authority is empowered to take necessary actions, including seeking federal approval, to facilitate the bill's provisions ahead of its official start date of January 1, 2026.

While the bill has garnered support for its potential to improve health outcomes for vulnerable populations, it may face scrutiny regarding funding and resource allocation within the Medicaid program. Advocates argue that the long-term benefits of better diabetes management could lead to reduced healthcare costs associated with diabetes complications.

As Oregon moves forward with this legislation, the implications for public health are clear: improved access to essential diabetes management tools could significantly enhance the quality of life for many residents, paving the way for similar initiatives in other states. The successful implementation of House Bill 2955 could serve as a model for comprehensive healthcare reform aimed at chronic disease management.