Medi-cal insulin pumps

My 6 year old was recently diagnosed t1d. Doing well with multiple daily injections, still not sure he wants to use an insulin pump.
My question is regarding medi-cal;
If we receive a pump, will medi-cal still cover insulin pens, and other supplies, if he decides not to use the pump?
Any insight would be very helpful.

Hi Jonathan. For the official word you should contact your insurer directly. Pump reps start the insurance process and may be knowledgeable about that as well.
Pumps typically have a 4-year commitment, with the exception of the Omnipod which is commitment free as the pods (pumps) are disposable. While pumps are considered the best way to manage Type1, many people do just fine on injections; so don’t feel pressured to get one, especially since your little guy is ok on and apparently fine with taking shots. And who knows what advances may be in place if he decides he would like one when he’s a little older.

I can’t answer the question about coverage, sorry, best to contact your insurer or the manufacturer you’re considering. I will comment that often the best people to contact are the manufacturer reps, they tend to know the magic words to use with the insurance/system operators and will sometimes intercede on your behalf. The decision on whether to use a pump is a personal choice, one that you should make with your child (if of reasonable age), some kids want nothing to do with them, some want tubeless, some want tubed…the reasons are endless and personal. You don’t mention if you have a CGM; my recommendation is get that prescribed first before a pump. The CGM’s type may dictate some pump choices. I also recommend you use this opportunity to involve your child, develop trust, involvement, and their decision inputs and reasoning. What do they “know”, what do they “want”, why, what are the restrictions involved, what are the impacts as they seem them and why, what pros and cons do they see, why, what do you see and why. Example: I’ve never had a tubed pump, I was MDI for a year, then went on Omnipod Dash pumps, followed shortly by incorporating Loop as a DIY (Do It Yourself) AID to merge my CGM and pump data as a treatment system; it takes some effort, but I’ve found it good for me. You and your child may see that as too much work and effort or you both may see it as appealing. It’s your choice. You may want to explore the likes Tandem T:Slim, Omnipod O5, or Beta Bionics iLet, the later two or “black box” approaches, i.e. you don’t see or have much input to the algorithms used. A word of caution: Many insurance companies will only cover certain devices every number of warranty years depending on their offerings/your choices; make sure you know those BEFORE having the discussion with your child (or have the child do some of the research), as you may have to cover part of the cost and not everyone can afford those costs (this too may be worked with/around depending on your coverage and the manufacturers involved). Depending on where you’re located (Canada, Europe, the US, etc.), your choices may be wider or narrower. There isn’t a simple answer to give you, would that there were! You may want to look elsewhere like IDS (, Gary Schiener’s Integrated Diabetes Services, he’s done a very thorough review of the pros and cons of most pumps available in the US and its on their website. And as always, feel free to contact those here with questions you still have on any pump or system; there’s very little that someone here hasn’t experienced or has an opinion on and willing to share it. Just remember this: You and your child need are the decision authorities; you have to be your own advocates as you’re the ones that will live the processes and results of the decisions; everyone else is an “advisor”…including your doctors, insurers, even those here on JDRF. YOU make the best informed decision yourself. Accept it will take time and effort on your part, you’ll make mistakes, you’ll get frustrated…that’s ok, give yourself a break and realize this is a marathon, not a sprint…it’s part of your child’s life, doesn’t define it (may seem to at times). We’ll look forward to hearing from you and offering advice, when asked.

Jonathan, medi-cal is a State of California operated Managed-Care program for individuals who coalify for benefits; each benefit recipient has a Case Manager. This question should be directed to your child’s manager for specifics.

The first question for you to answer, is “Why a pump?”, A pump isn’t a magic wand and by itself will not improve your child’s diabetes management, and it takes effort. MDI can be very effective diabetes management.

I believe Medi-cal would fall under general CMS guidelines and as such a durable pump would require a five year commitment - so best to speak directly with your Manager. As @wadawabbit pointed out, patch pumps are a pharmacy item, not DME, and the only item needed to make it work is a vial of insulin and a hand-held PDM.

Because your child is shy about making an almost permanent commitment, which is very understandable, I suggest that you limit your pump research to Lily, Insulet and, Roche devices.