Sponsors (8)
The bill substantially expands and speeds access to lung cancer screening and tobacco cessation—likely improving early detection and long‑term health outcomes for many low‑income and insured Americans—while increasing near‑term public and insurer costs, creating implementation burdens, and raising risks of overuse or cost‑shifting that could offset some benefits.
Millions of insured Americans — including Medicaid beneficiaries, Medicare beneficiaries, and people in employer and individual market plans — gain annual USPSTF/HHS-recommended lung cancer screening without prior authorization (and Medicaid beneficiaries get it without cost-sharing), improving timely access to potentially life‑saving early detection.
All Medicaid enrollees gain coverage for tobacco cessation counseling and FDA‑recommended pharmacotherapy without prior authorization (and inclusion in drug/rebate rules), expanding access to proven cessation treatments for low‑income populations.
Removing prior authorization requirements for screening and requiring MCOs/plans to cover cessation reduces administrative delays and barriers, speeding patient access and lowering clinician/provider administrative burden.
States, Medicaid managed care plans, Medicare, and private insurers face higher near‑term costs from increased screening and cessation coverage, which could raise state budgets, federal spending, or insurance premiums and affect taxpayers and enrollees.
Removing prior authorization and expanding screening risks increased tests for marginally eligible or low‑risk people, producing more false positives, downstream diagnostic procedures, overdiagnosis, and related patient harms and costs.
Insurers losing a utilization‑management tool may respond by tightening other cost controls (e.g., higher cost‑sharing, narrower networks), shifting costs and access barriers onto patients.
Based on analysis of 6 sections of legislative text.
Requires Medicaid, Medicare, Medicare Advantage, and private plans to cover annual USPSTF/Secretary-recommended lung cancer screening without cost-sharing or prior authorization; expands Medicaid tobacco cessation coverage, funds outreach, and mandates a GAO study.
Official title: To amend title XIX of the Social Security Act to require coverage under State plans under the Medicaid program for annual lung cancer screening with no cost sharing for individuals for whom screening is recommended by U.S. Preventive Services Task Force guidelines, to expand coverage under Medicaid of counseling and pharmacotherapy for cessation of tobacco use, and for other purposes.
Introduced November 20, 2025 by Kathy Castor · Last progress November 20, 2025
Requires Medicaid, Medicare, Medicare Advantage, and group/individual private health plans to cover annual lung cancer screening recommended by the U.S. Preventive Services Task Force or Secretary guidance, and bars cost‑sharing and prior authorization for those screenings. Expands Medicaid coverage of counseling and pharmacotherapy for tobacco cessation to all Medicaid enrollees (not just pregnant women), funds a targeted HHS education and outreach campaign, and directs a GAO study on gaps in screening and diagnosis. Most provisions take effect January 1, 2026 (private plan years and state-law exceptions have specified delayed effective dates). The bill also authorizes $10 million per year (FY2026–2030) for outreach and requires a GAO report within one year on populations missed by current screening guidelines and federal options to improve screening coverage for them.