The objective of this study is to test whether two different participant financial incentive structures are more effective and cost effective than minimal financial incentives in increasing weight loss among Minnesota Medicaid beneficiaries at high risk of developing diabetes. The incentives are tied to participation and weight loss in the evidence-based group-delivered YMCA diabetes prevention program (Y-DPP). The Investigators will conduct a group randomized trial that includes up to 150 Y-DPP classes of 10-15 participants per class for up to 1500 Medicaid beneficiaries participating in the Y-DPP classes. This approach, if successful, will (a) improve weight loss. diabetes risk, and improve cardiovascular risk among Medicaid beneficiaries at risk for developing diabetes and other chronic conditions, (b) demonstrate that prevention of chronic disease risk factors using patient incentives is cost-effective, and (c) provide a patient incentive model that can be widely used among Medicaid beneficiaries at risk for developing diabetes.

Inclusion Criteria:

• currently enrolled in Medical Assistance, PMAP, or MinnesotaCare (collectively referred to as Medicaid)
• 18-75 years of age
• body mass index ≥ 25 kg/m2 (≥ 22 kg/m2 for those of Asian descent)
• have prediabetes or a history of gestational diabetes mellitus (GDM)

Exclusion Criteria:

• diagnosis of diabetes
• pregnant at the time of enrollment
• planning gastric bypass surgery within the next 12 months
• diagnosed with Alzheimer's disease (ICD-9 331.0) or dementia (ICD-9 290.0 - 294.9)
• provider judgment regarding suitability for the study based on substance abuse, uncontrolled mental illness, or other conditions that may affect the participants health or ability to participate in the study.