Medicaid Coverage of Recommended Lung Cancer Screenings Varies Across States

Although lung cancer screenings are covered at no cost by most insurers, state Medicaid programs are not required to offer coverage for this service.

Lung cancer is the leading cause of cancer-related mortality in the United States, accounting for approximately 24% of overall cancer deaths, according to the American Lung Association. However, a new report indicates that Medicaid coverage of potentially life-saving lung cancer screening varies across states and many beneficiaries may be facing barriers to recommended screening.

Although Medicaid beneficiaries are disproportionately affected by lung cancer, standard Medicaid programs are not required to cover screenings. To determine the impact of these limitations, the analysis provided an investigation of lung cancer screening coverage policies in state Medicaid fee-for-service programs.

The US Preventive Services Task Force (USPSTF) recommends that high-risk individuals are annually screened for lung cancer. This includes individuals who are aged 55 to 80 years, have a smoking history of at least 30 pack years, and currently smoke or have quit within the last 15 years. Currently, 8 million Americans are considered at high risk and eligible for annual screening. According to the report, 26.3% of Medicaid beneficiaries are current smokers and the 5-year survival rate for lung cancer patients with Medicaid is significantly lower than for individuals with other forms of insurance. However, for standard Medicaid, coverage of USPSTF recommended screenings is not required.

For the analysis, the study authors from the Lung Association surveyed state Medicaid programs to obtain information on coverage of low-dose computed tomography (LDCT) scans for individuals at high risk for lung cancer and reviewed publicly available coverage policies. According to the report, 31 Medicaid fee-for-service programs cover lung cancer screening, 12 programs do not provide coverage, and 7 states did not have information available on their coverage policy. Medicaid programs also varied in eligibility criteria they used for screening and whether they required prior authorization. Although some programs used USPSTF criteria to determine eligibility, other programs used their own developed criteria that differ slightly and some have no formal eligibility criteria for screening.

The authors noted that the analysis only looked at lung cancer screening coverage in Medicaid fee-for-service programs and not across all Medicaid managed care plans in states. Overall, they concluded that the findings show that gaps remain in access to lung cancer screening for the Medicaid population and increased education is needed to improve coverage.

“Additionally, even when screening is covered, much more work is needed to educate patients and providers to remove barriers to screening that could improve the alarmingly low utilization of this service among those at high risk for lung cancer,” the authors wrote in the report.

The report is part of a partnership between The University of Texas MD Cancer Center and the American Lung Association to improve coverage for recommended LDCT lung cancer screenings in state Medicaid programs.

References

American Lung Association. Lung Cancer Screening Coverage in State Medicaid Programs. https://www.lung.org/assets/documents/lung-cancer/lung-cancer-screening-1.pdf. Accessed March 26, 2019.