HB 428 - SB 610
FISCAL NOTE
Fiscal Review Committee
Tennessee General Assembly
February 23, 2025
Fiscal Analyst: Chris Higgins | Email: chris.higgins@capitol.tn.gov | Phone: 615-741-2564
HB 428 - SB 610
SUMMARY OF BILL: Requires the Division of TennCare (Division) to provide coverage
for a continuous glucose monitor (CGM) for certain enrollees with a diabetes diagnosis, a history of
hypoglycemia, or who require the use of insulin. Requires the CGM to be prescribed by, or in
consultation with, an endocrinologist or healthcare practitioner with experience in diabetes
management who documents that the enrollee meets the established criteria.
Effective January 1, 2026.
FISCAL IMPACT:
STATE GOVERNMENT
EXPENDITURES General Fund
FY25-26 $534,900
FY26-27 & Subsequent Years $1,069,700
FEDERAL GOVERNMENT
EXPENDITURES
FY25-26 $964,300
FY26-27 & Subsequent Years $1,928,700
Assumptions:
• The proposed legislation will broaden the criteria currently utilized by the Division to
provide coverage for CGMs.
• According to information provided by the Division, there are currently 9,430 enrollees with
Type I or Type II diabetes who take insulin and do not utilize a CGM.
• It is estimated that at least 15 percent, or 1,415 (9,430 x 15%), of these enrollees will receive
a CGM based on the requirements of the proposed legislation.
• The average annual cost for a CGM is $2,119 per enrollee.
• Requiring additional coverage of CGMs will result in an increase in expenditures of
approximately $2,998,385 (1,415 individuals x $2,119) per year.
• Medicaid expenditures receive matching funds at a rate of 64.323 percent federal to 35.677
percent state. Of this amount $1,069,734 ($2,998,385 x 35.677%) will be in state funds and
$1,928,651 ($2,998,385 x 64.323%) will be in federal funds.
HB 428 - SB 610 2
• Due to the January 1, 2026 effective date, the increase in state expenditures is estimated to
be $534,867 ($1,069,734 x 50%) in FY25-26, and $1,069,734 in FY26-27 and subsequent
years.
• The increase in federal expenditures is estimated to be $964,326 ($1,928,651 x 50%) in
FY25-26, and $1,928,651 in FY26-27 and subsequent years.
IMPACT TO COMMERCE:
BUSINESS IMPACT
FISCAL YEAR REVENUE EXPENSES
FY25-26 $1,499,200 < $1,499,200
FY26-27 & Subsequent Years $2,998,400 < $2,998,400
Assumptions:
• Companies will experience an increase in business revenue of approximately $1,499,192
($2,998,385 x 50%) in FY25-26, and $2,998,385 in FY26-27 and subsequent years from
supplying CGMs.
• In order for businesses to remain solvent, any increase in expenditures will be less than the
amount of revenue collected.
• Any impact to jobs in Tennessee is estimated to be not significant.
CERTIFICATION:
The information contained herein is true and correct to the best of my knowledge.
Bojan Savic, Executive Director