To amend title XIX of the Social Security Act to require coverage of lung cancer biomarker testing under the Medicaid program.
Sponsors
Legislative Progress
IntroducedMr. Gottheimer (for himself and Mr. Rutherford) introduced the following …
Summary
What This Bill Does
This bill requires state Medicaid programs to cover lung cancer biomarker testing starting January 1, 2027. Biomarker testing helps doctors identify specific genetic mutations in lung cancer tumors, which allows them to prescribe targeted therapies that are often more effective than standard treatments.
Who Benefits and How
Low-income lung cancer patients enrolled in Medicaid benefit by gaining guaranteed access to biomarker testing that can guide more effective, personalized treatment options. Diagnostic testing companies and clinical laboratories performing biomarker tests will see increased demand and revenue. Pharmaceutical companies producing targeted cancer therapies may see expanded use of their drugs as more patients get tested.
Who Bears the Burden and How
State Medicaid programs must cover the cost of biomarker testing, which may increase program expenditures. Federal Medicaid matching funds will also increase to help cover these tests. Taxpayers ultimately bear the cost of expanded coverage.
Key Provisions
- Adds lung cancer biomarker testing as a required Medicaid covered service
- Effective date of January 1, 2027
- Amends multiple sections of Title XIX of the Social Security Act to incorporate the new coverage requirement
Evidence Chain:
This summary is derived from the structured analysis below. See "Detailed Analysis" for per-title beneficiaries/burden bearers with clause-level evidence links.
Primary Purpose
Amends the Social Security Act to require Medicaid programs to cover lung cancer biomarker testing beginning January 1, 2027, ensuring access to precision medicine for low-income patients.
Policy Domains
Legislative Strategy
"Mandate Medicaid coverage of precision medicine diagnostic testing to improve cancer treatment outcomes for low-income patients"
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
Key Definitions
Terms defined in this bill
Testing to identify genetic mutations or markers in lung cancer tumors to guide treatment decisions
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology