Background: In New York, Medicaid began covering diabetes self-management education and support (DSMES) services in 2009, but participation in these services remains low. This study sought to understand barriers and facilitators to referring and enrolling eligible Medicaid members to DSMES, and to yield recommendations for increasing referrals and enrollment.

Methods: We conducted 14 virtual focus groups with primary care providers, endocrinologists, and certified diabetes care and education specialists (CDCESs) in New York City and the rest of the state. We used an inductive-deductive coding process to identify common themes and recommendations across participant types.

Results: Participants recommended resources for addressing knowledge gaps about the benefits of DSMES and how to refer eligible Medicaid members: an online resource guide and directory of accredited services by location and insurance type; automated provider prompts; materials for exam rooms; and reimbursement guidance. Recommended strategies for disseminating resources to increase provider and patient awareness of DSMES included an advertising campaign targeting physicians and people with diabetes; academic detailing; e-mail blasts from credible sources (e.g., health department, Medicaid) ; and direct outreach (e.g., personal phone calls) to eligible Medicaid members.

Conclusions: Increasing participation in DSMES hinges upon increasing provider referrals and addressing barriers to participation. CDCESs in NY reported limited capacity to provide DSMES to referred patients in a timely manner, highlighting a need to expand the workforce to meet current and future demands should referrals increase with improved awareness and buy-in. Although the strategies and recommendations identified in this study reflect the perspectives of NY providers, they may have broad applicability to other states in which Medicaid covers DSMES.


L.Arena: None. N.S.Esquivel: None. R.Austin: None. S.Millstein: None. J.Kaelin-kee: None.


Centers for Disease Control and Prevention (CDC NU58DP006523)

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