Many State Medicaid Programs Flop for Lung Cancer Screening

When it comes to screening Medicaid patients for lung cancer, states need to do a better job, a report found.
“Lung cancer screening using low-dose computed tomography is recognized by the U.S. Preventive Services Task Force (USPSTF) with a Grade B rating, and therefore is a covered health benefit for Medicare and commercial insurance beneficiaries; it is not mandated for Medicaid,” noted the report commissioned by the LUNGevity Foundation, a Chicago-based group aimed at improving lung cancer survival rates. “Unfortunately, almost one-third of states do not cover lung cancer screening.”

When compared by region, screening rates were better for Northeastern states; 91% covered the screening, compared with Southern states, where only 50% covered it, according to the report, which was written by the consulting firm ADVI using publicly sourced data. A total of 66% of Midwestern states covered it, as did 61% of Western states.
Byron Crowe, MD, associate medical director at Solera Health, a Denver digital health company that creates programs to address chronic disease and social determinants of health, said it was “very exciting” to see that 66% of state Medicaid plans were covering the screening even thought they weren’t obliged to. “We’re optimistic about the other 33%” also deciding to cover it eventually, said Crowe, who spoke during a phone interview with a public relations person present. “We think coverage of these preventive services is a huge benefit to patients and should be something states embrace.” Crowe noted that more and more states have begun covering diabetes prevention programs, “and we’re hopeful more states will adopt coverage for other Grade A and B recommendations that aren’t now covered.”
The report also examined rates of coverage for lung cancer biomarker testing. “Last year, Medicare issued a National Coverage Decision (NCD) validating the clinical utility of NGS [next generation sequencing] panels for somatic mutation analysis in advanced malignancies (including lung cancer) and establishing coverage and payment for FDA-approved panels,” the authors noted. “Many, although not all, commercial insurers cover these panels as a medical benefit in lung cancer. Medicaid, however, is not bound by either Medicare NCDs or a commercial payer policy.” Overall, “we found that the vast majority of states did not have an explicit coverage policy for comprehensive biomarker testing, but that about 40% did provide coverage (as evidenced by paid claims) as a medical benefit.”
Finally, the authors looked at how many states covered the routine costs of clinical trials — procedures and services needed during the trial, excluding the drugs themselves — for experimental treatments for lung cancer and other diseases. They found that 24% of state Medicaid plans provided this coverage.
The report also graded individual states on five factors, giving them one point for each:

• Medicaid program covers lung cancer screening
• Medicaid fee-for-service program covers comprehensive biomarker testing
• Is a Medicaid expansion state
• Lung cancer incidence is less than the national average; currently lung cancer represents 13% of all cancers diagnosed nationwide
• State’s 5-year lung cancer survival rate is higher than the national average of 21.7%

The four states receiving an “A” grade — with 5 points — were Maryland, Minnesota, Oregon, and Washington; those with “F” grades — 0 or 1 point — included Alabama, Arkansas, Georgia, Idaho, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, and Tennessee.
“We recognize there is a lot of work to do,” the authors wrote, adding that their report “establishes a baseline to measure improvements (or lack thereof) in how lung cancer care is delivered, and to identify pain points and opportunities in the system that we can address to improve patient access to better care, including precision medicine treatments.”
https://www.medpagetoday.com/hematologyoncology/lungcancer/84779