Insulin pump
(David J. Phillip / AP)

People with diabetes cost the state's Medicaid program twice as much as those without the chronic condition, a study commissioned by the society that represents Maryland's doctors has found

Medicaid spent an average of $24,387 on each patient with diabetes in 2014, compared with $10,880 for someone without the disease, according to the study commissioned by MedChi and conducted by the Hilltop Institute at the University of Maryland, Baltimore County and released Thursday. There were similar findings among enrollees in 2013, according to the study of adults ages 35 to 64.


Such spending adds up to hundreds of millions of dollars annually. HealthChoice, which manages care for the bulk of the state's Medicaid patients, spent more than $471 million treating people with diabetes in 2014 for hospitalizations, doctor visits and prescriptions, and more than $312 million in 2013.

Diabetes occurs in people who do not produce enough insulin or do not process it correctly, causing an increase in blood sugar. It affects 29 million Americans and more than 610,000 Marylanders, or about 10 percent of the state population.

The cost of caring for diabetes patients builds up over time because the disease often causes costly complications, such as kidney failure and gangrene leading to amputations. HealthChoice enrollees with diabetes were more than twice as likely to be admitted to a hospital as those without the disease.

MedChi said the research is the first look at the cost of caring for diabetics on Medicaid in Maryland, and advocates say it could provide fuel for policy and legislative changes at the state and local levels.

"These numbers really show the burden in Maryland," said Dr. Richard Bruno, a MedChi trustee and a board member of the advocacy group Sugar Free Kids Maryland. "We have some suggestions to make a dent."

Since obesity is a big risk factor in the most common form of diabetes, Bruno said, public education about diet and exercise is crucial. The report suggests remedies for policymakers and lawmakers that include adding diabetes screenings, developing walkable communities, and making fresh fruits and vegetables more accessible in poor neighborhoods.

The report also recommends some more controversial measures, such as taxes on surgary drinks, requiring warning labels about those drinks in retail outlets, and "healthy vending" laws that require most foods and drinks sold on government property to be lower-calorie.

A bill requiring that 75 percent of the options in vending machines on state property meet a set of dietary guidelines failed in the General Assembly this year, though sponsors said they plan to reintroduce the measure. Howard County and Baltimore City already have such laws.

An effort also stalled in Baltimore City to require businesses that sell or advertise sugar-sweetened sodas, energy drinks, sports drinks, juices, coffees and teas to post signs warning consumers that they contribute to tooth decay, obesity and diabetes.

City Councilman Nick Mosby said he was moved to introduce the bill by the number of obese children in Baltimore who could face a lifetime of battling related diseases. He said he was disappointed that the measure has not gotten a vote.

"In Baltimore, we're going to be the leader in policy reforms and progress on things like this, or, unfortunately, we'll continue to see the impacts," he said. "We've already allowed the impacts on the city for far too long."

While Mosby said the warning labels did not restrict choice among consumers and only provided information, representatives of the beverage industry argue that consumers are already getting enough information to make purchasing decisions.

Ellen Valentino, a lobbyist for the Maryland-Delaware-D.C. Beverage Association, opposed Mosby's bill and said the industry is already offering more choices with fewer calories and providing calorie counts on the products.

"We know government in every grocery cart is not a real solution," she said. "Real solutions are providing consumers choice, smaller portion sizes, lower calorie options and information on packaging."


Policymakers say they continue to work on other preventive programs to reduce obesity and the rate of diabetes — and the costs.

The Maryland Department of Health and Mental Hygiene, which administers the Medicaid program for the federal government, said in a statement that the agency is participating in a national diabetes prevention program.

The state health department announced this summer that it had chosen four managed-care organizations under HealthChoice — Amerigroup, Jai Medical Systems, MedStar Family Choice and Priority Partners — to help implement diabetes prevention programs for Medicaid patients as part of a two-year pilot study by the federal government.

Maryland is one of two states that were awarded funding as part of the National Diabetes Prevention Program, which is focused on keeping low-income residents from developing diabetes

"The department welcomes the study and shares the concern about the impact of diabetes," the statement said. "For this reason, the Department of Health and Mental Hygiene, this summer, selected the managed care organizations that will participate in a demonstration project to show ways to offer the National Diabetes Prevention Program to Medicaid recipients."

But without more intervention, others fear that diabetes patients will continue to drive up spending. The MedChi study already found that more than a quarter of Medicaid's 2014 spending of $1.77 billion on patients ages 35 to 64 was for diabetics, though they made up only 14 percent of enrollees.

"The burden on our patients, their families and state taxpayers will continue to intensify, putting strain on Medicaid funding, enrollment, and perhaps even the quality of care provided," said MedChi's president, Dr. Stephen J. Rockower.