In rolling out a first-of-its-kind program to prevent diabetes, Medicare officials dashed the hopes of many startups in 2017 by deciding to exclude online health companies from participation.

Since the program’s launch, however, large cracks have formed in Medicare’s service network. The program, which offers classes to improve diet and exercise habits, has no providers in Alabama or Mississippi — states in the heart of the so-called diabetes belt — and only one in Georgia, according to a federal database of more than 460 participants.

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