Medicaid Claims-Based Diabetes Self-Management Education and Support Utilization in Adults With Diabetes: Sociodemographic and Geographic Assessments

PURPOSE: The purpose of this study was to examine diabetes self-management education and support (DSMES) utilization in the Medicaid population with diabetes to obtain actionable information to encourage uptake. METHODS: This pooled cross-sectional study analyzed Transformed Medicaid Statistical Information System Analytic Files from 2016 to 2023 for adults ages 19 to 64 years with diabetes (N = 3 735 182). Descriptive and bivariate analyses were used to examine the sociodemographic characteristics (eg, sex, race/ethnicity) and geographic patterns (eg, rural/urban status) of ever-utilization of DSMES. RESULTS: Overall, 5.6% (n = 210 078) of study beneficiaries with diabetes received ≥1 DSMES encounter. Utilization was higher among females (6.2%) and younger adults ages 19 to 34 years (7.5%). DSMES was received by 8.9% of non-Hispanic (NH) multiracial beneficiaries, 7.5% of Hawaiians/Pacific Islanders, 7.4% of NH Asians, 6.7% of NH Whites, 5.6% of NH Blacks, 4.6% of NH American Indians/Alaska Natives, and 4.4% of Hispanics. Utilization was higher in counties with a lower Social Vulnerability Index (8.7% in the lowest quartile) and slightly higher for those living in rural areas (6.2%) than those in urban areas (5.8%). State-level variation was substantial (0.1%-32.0%), although some differences likely reflect variation in data completeness, coding practices, and encounter reporting across state Medicaid programs. By state, there was substantial variation in DSMES utilization across counties (eg, in West Virginia, utilization rates ranged from 1.5% to 18.2%). Many DSMES suppliers were concentrated in counties associated with big cities, and many counties still lacked a DSMES supplier. CONCLUSIONS: DSMES utilization among Medicaid beneficiaries was low and highly uneven across demographic groups and geographic locations. These findings offer insights that can inform strategies and policies aimed at promoting equitable access and uptake.