Medicaid Expansions: Probing Medicaid’s Filling of the Cancer Genetic Testing and Screening Space

Abstract

Cancer is the third largest source of spending for Medicaid in the United States. A working group of the American Public Health Association Genomics Forum Policy Committee reviewed 133/149 pieces of literature addressing the impact of Medicaid expansion on cancer screening and genetic testing in underserved groups and the general population. Breast and colorectal cancer screening rates improved during very early Medicaid expansion but displayed mixed improvement thereafter. Breast cancer screening rates have remained steady for Latina Medicaid enrollees; colorectal cancer screening rates have improved for African Americans. Urban areas have benefited more than rural. State programs increasingly cover BRCA1/2 and Lynch syndrome genetic testing, though testing remains underutilized in racial and ethnic groups. While increased federal matching could incentivize more states to engage in Medicaid expansion, steps need to be taken to ensure that they have an adequate distribution of resources to increase screening and testing utilization.

Randomized trial promoting cancer genetic risk assessment when genetic counseling cost removed: 1-year follow-up

“…For instance, Medicare requires genetic counseling with a genetic counselor to be billed only under physician supervision ( 30 , 53 , 54 ), forcing some patients to pay out of pocket. Medicaid covers genetic counseling and testing for HBOC in most states, but the specific requirements and limits vary by state ( 28 ). Moreover, genetic counseling is less likely to be reimbursed than genetic testing; the latter is more often covered by insurance and patient assistance programs ( 47 , 48 ).…”

“…Although the cost of clinical genetic services has decreased over recent years, many people continue to experience financial barriers ( 25-27 ). Under the Patient Protection and Affordable Care Act, most private insurers are required to pay for HBOC genetic counseling and BRCA1/2 testing in cancer patients who are at high risk ( 9 , 28 , 29 ). However, the actual coverage for genetic counseling and testing varies by insurance type, medical facility, and testing laboratory ( 29-31 ).…”

Public Service Engagement: Resting Ground for Specialized Ability or Garden for Multidisciplinary Talent?

“…Rather than forming a separate working group, I led the entire Committee in discussion and literature gathering. These activities yielded multiple products, among them a policy statement citing disparities in cancer diagnostic services, accepted and disseminated by APHA in 2013, and published articles dealing with the rights of immigrant groups (Modell et al, 2021) and underserved groups and Medicaid (Modell et al, 2022). These products pertained to group resource access and social justice requiring a multidisciplinary expansion of knowledge, added to by the ground level gaining of experience in group dynamics to see the efforts to completion.…”

A cost-utility analysis of BRCA1 and BRCA2 testing in high-risk breast cancer patients and family members in Thailand: a cost-effective policy in resource-limited settings

“…Addressing the financial constraints through the Affordable Care Act (ACA) seemed to increase the uptake of gBRCA in marginalized populations (5). Relaxed testing criteria, from the USPSTF 2005 to the National Comprehensive Cancer Network (NCCN) guideline, is being adopted to expand the high-risk territory (6). To date in the United States, the cost of genetic counseling and testing are being covered under Medicare or Medicaid in most states.…”