Advanced Cancer Testing Mandated for Medicare, Medicaid, and CHIP: Deductibles Waived for Seniors

The Finn Sawyer Access to Cancer Testing Act is designed to expand access to cutting-edge cancer diagnostics for millions of people covered by federal health programs. Simply put, this bill mandates that Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) must cover advanced genetic and molecular cancer tests, like DNA and RNA sequencing, when used to diagnose or plan treatment for cancer patients. This isn't about covering basic lab work; it’s about covering the kind of high-tech testing that helps doctors personalize treatment, potentially making it much more effective.

The End of the Deductible Barrier for Seniors

For anyone on Medicare Part B, this bill provides a significant financial break. When you get one of these covered cancer diagnostic tests, the usual Part B deductible is waived. Think of it this way: if you’re a senior managing a new cancer diagnosis, you won't have to hit that annual deductible out-of-pocket before Medicare starts covering the cost of getting your tumor genetically sequenced. Medicare will pay 80% of the cost, based on a set rate, starting six months after the bill is signed into law. This is huge for patients because these advanced tests can be expensive, and removing the deductible barrier means faster access to better treatment planning.

However, there is a catch on the payment side. Medicare will only cover 80% of the cost, meaning the patient still owes the remaining 20% coinsurance. Since Medicare payment is based on the lower of what the lab charges or what Medicare usually pays for similar tests, patients could still face substantial bills if the lab charges significantly more than the Medicare rate. Also, Medicare sets frequency limits: you generally get coverage for these specific genetic tests once at initial diagnosis, once if the cancer recurs, and then as needed to monitor treatment effectiveness.

Mandating Coverage for Families and Low-Income Adults

The bill also forces state-run programs to catch up on modern cancer care. For CHIP, which covers low-income children and pregnant women, coverage for these advanced diagnostic tests must begin by January 1, 2025. This is the fastest implementation timeline in the bill, ensuring kids and expectant mothers get access quickly. For Medicaid, which covers low-income adults, the mandate starts on January 1, 2027. This staggered timeline acknowledges that states need time—and sometimes legislative action—to update their Medicaid plans and budgets.

If you’re a state Medicaid director, this bill means you have a hard deadline to ensure your program covers these specific tests. If you’re a working parent enrolled in Medicaid, this means your cancer treatment plan will be based on the latest genetic information, not just standard protocols, which could lead to more precise and less toxic treatments.

Closing the Knowledge Gap

It’s one thing to mandate coverage; it’s another to make sure doctors know how to use it. That’s where Section 3 comes in. The bill requires the Department of Health and Human Services to set up a new education and awareness program focused on genomic testing. This program targets both the public and, critically, healthcare providers. They specifically need to push for training in medical schools and continuing education for practicing doctors on the importance of using molecular diagnostics when cancer is first found or comes back.

This provision recognizes that advanced testing is useless if doctors aren't ordering it or don't know how to interpret the results. By focusing on training, the bill aims to ensure that when patients gain access to these tests, they are being ordered and used correctly by a well-informed medical community.