What could Medicaid changes mean for people with diabetes as hundreds of thousands face potential coverage losses and millions encounter higher healthcare costs?
Nearly 500,000 people with diabetes who currently receive Medicaid could lose their health coverage by 2034 under recent policy changes, while another 1.5 million could face new out-of-pocket costs, according to a new analysis commissioned by the American Diabetes Association. ()
Nearly half a million Americans living with diabetes could lose Medicaid coverage over the next eight years, raising concerns about whether patients will be able to continue accessing medications, routine medical care and the services needed to manage a chronic condition.
The projection comes from an analysis commissioned by the American Diabetes Association and conducted by Health Management Associates. The researchers used Congressional Budget Office projections along with Medicaid enrollment and claims data from the Centers for Medicare & Medicaid Services to estimate how recent policy changes could affect people with diabetes.
The analysis estimates that almost 500,000 Medicaid beneficiaries with diabetes could lose coverage by 2034 if current policies remain in place. The impact is expected to be particularly pronounced among people living in rural communities and in states that expanded Medicaid under the Affordable Care Act.
At the same time, about 1.5 million Medicaid enrollees with diabetes who retain coverage could face new cost-sharing requirements by 2029. In some states, the additional out-of-pocket burden could reach approximately $1,000 a year.
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Why Medicaid Coverage Matters For People With Diabetes
For people living with diabetes, health insurance is often tied directly to their ability to manage the disease.
Diabetes care can involve regular doctor visits, blood glucose monitoring, prescription medications, insulin, diabetes education and technology such as continuous glucose monitors. Losing coverage can make those services harder to afford and may lead some patients to delay or skip care.
The American Diabetes Association warned that gaps in coverage could have consequences beyond individual patients, potentially contributing to more diabetes-related complications, hospitalizations and emergency room visits.
Research cited in the report has also found that adults with low incomes who experience interruptions in health insurance tend to have poorer blood glucose management and may require more medication over the long term.
That makes the projected coverage losses particularly significant for people whose diabetes already requires consistent treatment and monitoring.
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Nearly 500,000 Could Lose Medicaid Coverage
The study estimates that nearly 500,000 Medicaid beneficiaries with diabetes could lose coverage by 2034.
The researchers found that the projected losses will not be evenly distributed across the country. People living in states that expanded Medicaid under the ACA are expected to account for much of the impact.
Rural communities could also face a disproportionate burden.
According to the analysis, people with diabetes living in rural areas are expected to account for about 18% of projected Medicaid coverage losses nationally. In some Southern states, the share of rural Medicaid enrollees with diabetes who could lose coverage could reach 58%.
For rural patients, losing Medicaid may be particularly difficult because alternative sources of affordable healthcare can be limited. A coverage loss may mean traveling farther for care, finding a new provider or delaying treatment because of cost.
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Provider Tax Changes Could Drive A Large Share Of Losses
The analysis points to several policy changes that could contribute to Medicaid coverage losses.
State provider tax changes are projected to account for approximately 45% of the Medicaid coverage losses among people with diabetes, according to the analysis.
Other factors include changes involving eligibility assessments, community engagement requirements and efforts intended to reduce erroneous Medicaid payments.
The combined effect could create additional administrative hurdles for beneficiaries.
For patients who already face challenges managing a chronic illness, losing coverage because of eligibility changes or administrative requirements could create another barrier to consistent care.
1.5 Million Could Face New Healthcare Costs
Coverage loss is not the only concern raised by the analysis.
Approximately 1.5 million Medicaid beneficiaries with diabetes are expected to remain covered but face new cost-sharing requirements by 2029.
Those costs could be significant for people with limited incomes. In some states, average additional out-of-pocket expenses could reach around $1,000 per year.
For someone managing diabetes, that additional expense could compete with other household needs.
Patients may have to make difficult choices about paying for prescriptions, monitoring supplies, physician visits or other healthcare services.
Even when a person technically remains insured, higher costs can make it harder to use that coverage consistently.
The Impact Could Be Greater In The South
The South is expected to experience a particularly significant impact.
The region has higher rates of diabetes than many other parts of the United States, and the ADA analysis projects that roughly 70% of potential ACA individual-market coverage losses among people with diabetes could occur in the South.
That creates a double concern for patients in the region.
People who lose Medicaid may attempt to move into the individual insurance market, but changes to ACA premium assistance could make replacement coverage less affordable for some people.
The result could be gaps in insurance at a time when patients need uninterrupted access to diabetes care.
ACA Changes Could Affect Another 654,000 People
The analysis also examined the possible effect of changes to the Affordable Care Act’s individual insurance market.
It estimates that as many as 654,000 people with diabetes enrolled in ACA individual-market plans could experience coverage losses between 2025 and 2027, with approximately 70% of those losses occurring in the South.
These individuals are separate from the nearly 500,000 Medicaid beneficiaries projected to lose coverage by 2034.
Together, the findings point to a broader concern: people with diabetes could face instability in both Medicaid and the individual insurance market as policy changes take effect.
Insulin Costs Remain A Major Concern
The potential loss of insurance comes as many people with diabetes continue to struggle with the cost of insulin.
A recent survey cited by the ADA found that 72% of insulin users surveyed said they pay more than $35 per month, while nearly 40% reported paying more than $150 per month.
The Inflation Reduction Act introduced a $35 monthly insulin copay cap for people with Medicare Part D. Drug manufacturers, including Eli Lilly, Novo Nordisk and Sanofi, have also announced lower-cost insulin options.
But those measures do not cover everyone who uses insulin.
People with commercial insurance, Medicaid changes or no insurance may face different costs depending on their coverage and eligibility.
New Legislation Could Cap Insulin Costs
Lawmakers are also considering legislation aimed at making insulin more affordable for people with private insurance.
The Affordable Insulin Now Act of 2026, introduced in the Senate, would establish a $35 monthly cost-sharing limit for insulin under private insurance and create an access pathway for uninsured people who need insulin.
The legislation comes as policymakers and patient advocates debate how to maintain access to essential diabetes medications while broader changes to healthcare coverage take effect.
For patients who lose Medicaid and move into private insurance, the cost of insulin could become an important part of whether they can maintain treatment.
What The Coverage Changes Could Mean For Patients
The potential consequences go beyond losing an insurance card.
Diabetes requires ongoing management. Patients often need regular testing, medication adjustments and monitoring to prevent complications.
A disruption in care can make it harder to keep blood glucose levels under control.
Over time, poor management can increase the risk of serious complications, including cardiovascular disease, kidney problems, nerve damage, vision problems and other health issues.
That is why healthcare advocates are concerned that coverage losses could eventually increase pressure on hospitals and emergency departments.
The ADA has warned that greater numbers of uninsured or underinsured patients could lead to increased hospitalizations, diabetes complications and emergency care.
Rural Patients Could Face A Particularly Difficult Road
The projected impact on rural communities is another major concern.
Rural residents can already face limited access to primary care physicians, endocrinologists, pharmacies and diabetes specialists.
When Medicaid coverage disappears, patients may have fewer affordable alternatives.
In some cases, the nearest healthcare provider may be many miles away. Transportation costs and time away from work can create additional barriers.
For patients who rely on regular monitoring and medication, even a short interruption can become significant.
The ADA Is Calling For Policy Changes
The American Diabetes Association is urging federal and state policymakers to take steps to protect people with diabetes from losing access to care.
The organization has called on the Centers for Medicare & Medicaid Services to broaden the proposed definition of medical frailty so that Medicaid beneficiaries with diabetes who are unable to work are not unnecessarily removed from coverage.
The ADA is also encouraging states to explore ways to preserve Medicaid coverage for people living with chronic diseases.
The organization argues that maintaining access to care could help prevent complications and reduce costs associated with emergency treatment and hospitalizations.
A Larger Healthcare Coverage Debate
The projected impact on people with diabetes is part of a much larger debate over the future of Medicaid.
Recent policy changes are expected to reduce federal Medicaid spending and introduce new requirements and restrictions affecting eligibility and enrollment.
The Congressional Budget Office and other organizations have projected that millions of people could eventually lose Medicaid coverage under the broader changes.
The new ADA analysis narrows that question to one particularly vulnerable population: people living with diabetes.
For these patients, the consequences of losing coverage may be especially immediate because diabetes management depends on regular access to healthcare and medication.
What Happens Next?
The impact of the policy changes will unfold over several years rather than all at once.
States will determine how certain Medicaid changes are implemented, while beneficiaries will face eligibility assessments and other requirements.
Patients who lose Medicaid may seek coverage through employer plans, ACA marketplace plans or other sources of insurance.
But whether affordable alternatives are available will depend heavily on where someone lives, their income and the type of coverage for which they qualify.
Healthcare providers will also be watching closely for signs that coverage disruptions are leading to delayed care, medication interruptions or increased emergency treatment.
A Warning For People Living With Diabetes
The projected loss of Medicaid coverage for nearly 500,000 people with diabetes is not simply a statistic about insurance enrollment.
For many patients, Medicaid helps pay for the routine care and medications that keep a chronic condition under control.
The new analysis suggests that nearly half a million people could lose that safety net by 2034, while another 1.5 million could face higher out-of-pocket costs even if they remain insured.
The effects are expected to be felt most heavily by rural communities and residents of Southern states.
As policymakers debate Medicaid changes, insulin affordability and healthcare spending, the central question for patients is increasingly practical: Will they be able to afford the care they need to manage diabetes every day?
For hundreds of thousands of people, the answer could depend on how these policies are implemented and whether additional protections are put in place.
References:
- Impact of Recent Medicaid Changes on Health Insurance Coverage for Americans with Diabetes – (http://efaidnbmnnnibpcajpcglclefindmkaj/https://diabetes.org/sites/default/files/2026-07/Affordable%20Care%20White%20Paper%20FINAL.pdf)
Source-Medindia