The Centers for Disease Control and Prevention estimates that 86 million adults, 22 million of those 65 or older, are prediabetic.  Prediabetes, which increases the risk for heart disease, stroke, and diabetes, is a condition in which patients have increased blood sugar levels but not high enough to be considered diabetes.  On Wednesday, the Obama administration plans to propose expanding Medicare to cover programs to prevent diabetes through “lifestyle change programs” in which trained counselors promote healthier eating habits and increased physical activity. 

The expansion in coverage is possible under Affordable Care Act provisions, which President Obama signed six years ago.  The coverage expansion comes after the Y.M.C.A. received a 2012 federal grant of $12 million to test the value of diabetes prevention programs in eight states.  After evaluating the results of the study, Sylvia Mathews Burwell, the Secretary of Health and Human Services, said the “program has been shown to reduce health care costs and help prevent diabetes.”

Specifically, Medicare saved $2,650 for each person enrolled in the prevention program over 15 months compared to similar people not enrolled in the program.  The cost savings more than make up for the cost of the program, according to officials at CMS.  Participants also lost about 5 percent of their body weight, significantly reducing their risk of diabetes.

The proposal, set to be announced at a Y.M.C.A. in Washington, D.C., must go through a period of public comment.  However, after a 2010 change in Medicare, the Secretary can expand programs such as these if she finds, and the Medicare actuary agrees, they would reduce spending without reducing the quality of care.  Because the proposal does not need congressional approval, there is little doubt it will be expanded nationwide.

A press release on the expansion is available here.  The Office of the Actuary certification is available here.

Reporter, Scott Cameron, Sacramento, CA, +1 916 321 4807, scameron@kslaw.com.