CMS has selected 10 states to study the effectiveness of incentives to prevent chronic disease among Medicaid beneficiaries. Minnesota is focusing on preventing diabetes. Almost 30% of Americans 20+ years of age have prediabetes and are at high risk of developing diabetes. The Diabetes Primary Prevention Lifestyle program is effective in reducing the incidence of diabetes by 34% over 10 years and in a group delivery format is potentially cost-saving. Financial incentives can be effective for changing behaviors but many questions remain such as in what populations, how often, in what increments and total amounts, over what period of time, should they be goal-driven, and what is the effect based on individual or group performance? The objective of this study is to test two different patient incentive structures among 18-74 year old Minnesota Medicaid beneficiaries at high risk of developing diabetes. The incentives are tied to participation and weight loss in the group-delivered YMCA diabetes prevention program (Y-DPP). This is a prospective group randomized trial with Y-DPP classes as the unit of analysis. Up to 350 classes with up to 3500 participants will be randomized to one of three study conditions: a) Control: The 12-month Y-DPP program; b) Individual Incentives: The 12-month Y-DPP program with a tiered incentive structure for program participation and weight loss. All incentives are dependent on the individual actions of the Medicaid beneficiary; c) Group Incentives: This is a combination of individual incentives plus tiered incentives based on overall class attainment of participation and weight loss.