Objective
The project’s four main objectives are to:
1. Expand Reach and Service Delivery: We will implement effective communication and engagement strategies to connect with underserved adults living with T1D. This includes new outreach campaigns in English and Spanish, partnerships with local clinics (including federally qualified health centers, free and charitable clinics, and safety-net hospitals), community-based organizations, collaborations with other nonprofit organizations, and digital campaigns.
2. Enhance Medicaid Navigation: Medicaid coverage and rules vary by state, making it hard for people to access and use benefits effectively. Pending changes to Medicaid policy will further complicate access and coverage for people living with T1D. We will create state-specific guides, tools, and training so that our staff can help participants understand and maximize their coverage, ensuring they get the devices, supplies, and medications they need.
3. Strengthen Transition of Care: BCH will refine our transition systems and processes to help participants complete our program with access to long term, sustainable resources including access to insurance, financial assistance for prescriptions, primary or endocrinology care, community support, and options for program extension and re-enrollment when needed.
4. Enhance Data Collection and Analysis Systems: We will enhance our data systems to track key health outcomes, like diabetes distress, A1c levels, and access to needed resources, so we can measure what’s working, identify gaps, and keep improving.
Together, these efforts will help more underserved adults with T1D gain the care, confidence, and support to manage their condition successfully.
Background Rationale
Managing type 1 diabetes is a 24/7 challenge, and for people with fewer resources, it can be overwhelming and dangerous. In the United States, the average cost of diabetes care is more than $19,000 per person per year (Parker et al., 2024). Many people cannot afford the insulin, devices, and support they need. Four out of five individuals with T1D report taking on debt to cover these costs (CharityRx News, 2022). Only one in four achieve healthy blood sugar levels (Hankosky et al., 2023).
The reasons are not personal failures; they are systemic ones:
- Over 70% of U.S. counties lack a single endocrinologist (Marsh, 2024).
- Medicaid coverage for diabetes devices like continuous glucose monitors varies by state.
- Uninsured adults often ration insulin or skip doses, risking hospitalization or death (Hill-Briggs et al., 2021).
BCH was created to change this reality. Funded by the Helmsley Charitable Trust, BCH provides free, virtual care to adults with T1D. Since 2024, we have served over 1,000 participants in 17 states and Washington D.C. Participants in the program achieve clinically meaningful and statistically significant reductions in diabetes distress and A1c, and high levels of participant satisfaction (Gomberg et al., 2025).
This Breakthrough T1D grant will allow us to extend this impact by reaching more underserved populations, enhancing tools to navigate Medicaid more effectively, improving the transition to long-term care, and strengthening the data systems that help us continuously learn and improve.
Description of Project
Blue Circle Health is a 501(c)(3) public charity that provides free, virtual care, education, and support to adults living with type 1 diabetes (T1D). Blue Circle was created to address the gaps in care imposed by the US healthcare system that make it difficult, and often impossible, for people to get what they need to live healthy, full lives.
This grant will help Blue Circle Health expand and strengthen services delivered to underserved adults living with T1D. Specifically, this investment will allow us to:
1. Expand our reach via the development and execution of outreach campaigns that connect more underserved people with our free services.
2. Enhance and expand Medicaid navigation by developing state-specific tools, training, and workflows that make it easier for participants to access benefits, medications, and diabetes technology.
3. Strengthen the transition of participants from the Blue Circle Health program into sustainable access to resources including connection to primary care physicians, endocrinologists, insurance coverage, community, medicine, and supplies.
4. Enhance data collection and analysis systems to measure progress, track outcomes, and continuously improve the quality and reach of our services.
Anticipated Outcome
By the end of this three-year project, BCH will have expanded its program reach, enhanced Medicaid navigation, strengthened continuity of care, and evolved a robust data infrastructure to track and improve outcomes.
We expect to:
1. Increase the number of enrolled underserved adults living with T1D in the BCH program;
2. Train staff and partners across multiple states in Medicaid navigation best practices;
3. Strengthen our transition processes and resources for people exiting the program; and
4. Enhance data analysis systems for tracking metrics including engagement, clinical outcomes, and participant satisfaction, driving ongoing quality improvement.
Ultimately, our goal is to make BCH a model for how equitable, person-centered diabetes care can work, proving that better health outcomes and lower costs are both possible and available.
Relevance to T1D
Our largely for profit, fee-for-service healthcare system creates barriers to accessing nearly everything people with T1D need to live healthy lives including care, education, support, medicine, technology, and supplies. The result is preventable suffering, hospitalizations and early death, especially among people who are uninsured, low-income, or underinsured (Hill-Briggs et al., 2021).
BCH exists to close that gap. Our work directly addresses the key barriers that keep people from achieving good diabetes management: lack of access, lack of education, and lack of coordinated support. Since launching our program in January of 2024, we have helped more than 1,000 people in 17 states and the District of Columbia, reduce diabetes-related distress and lower their A1cs (Gomberg et al., 2025).
With Breakthrough T1D’s support, BCH will help ensure that more underserved people living with T1D, regardless of circumstance, can access the resources, supplies, care, and skills they need to live well. In the process, we’ll make clear to the type 1 diabetes community that better care is not only possible but can be made available across the US.