Sponsors (7)
The bill expands access to lung cancer screening and tobacco cessation—especially for Medicaid enrollees—likely improving early detection and long‑term health outcomes, but it increases near‑term costs for state and federal programs and insurers and creates implementation and capacity challenges that could shift costs or produce uneven access.
Medicaid enrollees who meet USPSTF criteria gain annual lung cancer screening covered with no cost‑sharing, removing a major financial barrier for low‑income people and likely increasing early detection.
People with Medicare and people in employer and individual market plans receive annual USPSTF‑recommended lung cancer screening without prior authorization (and Medicaid managed care must also cover without prior authorization), speeding access to screening across public and private payers.
All Medicaid enrollees gain coverage for tobacco cessation counseling and FDA‑recommended pharmacotherapy without prior authorization, expanding treatment access beyond pregnant women and supporting smoking cessation among low‑income populations.
States, Medicaid managed care plans, Medicare, and private insurers will face higher near‑term costs from increased screening and cessation coverage, which could raise state budgets, federal spending, or insurance premiums.
Insurers (and possibly employers) may respond to higher screening costs by raising premiums, increasing cost‑sharing elsewhere, or narrowing networks, shifting costs to patients and families.
Providers, state Medicaid programs, and managed care organizations will incur administrative and operational burdens—updating contracts, formularies, IT systems, and workflows—to implement new coverage rules, causing short‑term complexity and one‑time costs.
Based on analysis of 6 sections of legislative text.
Requires coverage of annual lung cancer screening and tobacco-cessation services without cost-sharing or prior authorization across Medicaid, Medicare, and most private plans; funds outreach and orders a GAO study.
Introduced November 20, 2025 by Kathy Castor · Last progress November 20, 2025
Requires Medicaid, Medicare, and most private group and individual health plans to cover annual lung cancer screening recommended by the U.S. Preventive Services Task Force (or Secretary-issued guidelines) without cost-sharing or prior authorization, and expands Medicaid coverage of tobacco cessation counseling and medicines to all beneficiaries. It also funds a targeted HHS education and outreach campaign and orders a GAO study on screening gaps. Most coverage and prior-authorization prohibitions take effect January 1, 2026 (private plans apply to plan years beginning on or after January 1, 2026), though states that need to change state law get a delayed compliance date tied to their legislative sessions. The bill authorizes $10 million per year (FY2026–2030) for outreach activities and requires a GAO report within one year on populations missed by current screening guidelines.