Sponsors (2)
The bill significantly expands access to lung cancer screening and tobacco‑cessation services—likely improving early detection and quit rates—but does so at increased cost and administrative burden, with risks of capacity strains and some inappropriate use if guidelines or implementation lag clinical evidence.
Medicaid, Medicare, and people with employer or individual coverage will have broader access to annual lung cancer screening (where USPSTF recommends) with reduced cost and administrative barriers, increasing early detection.
All Medicaid enrollees will gain guaranteed, no-cost tobacco and e‑cigarette cessation counseling and FDA‑recommended pharmacotherapy (without pregnancy limits and without prior authorization), lowering out-of-pocket costs and likely increasing quit attempts.
Hospitals, imaging providers, and clinicians should experience faster care delivery and fewer authorization denials for recommended lung cancer screening, reducing administrative delays for patients.
States, insurers, and taxpayers will likely face higher near‑term and ongoing costs from expanded annual lung cancer screening and broader cessation coverage, increasing pressure on state Medicaid budgets and federal/insurer spending.
Implementing coverage changes requires state Medicaid and managed‑care plan updates, contract revisions, and in some cases enabling legislation, imposing administrative burden, compliance costs, and possible delays in beneficiary access.
Removing prior authorization and locking in USPSTF recommendations as of March 9, 2021 could reduce payers' ability to verify guideline adherence, risk some inappropriate screening use, and create tension if clinical guidance evolves.
Based on analysis of 6 sections of legislative text.
Mandates no‑cost, no‑prior‑authorization annual lung cancer screening coverage across Medicaid, Medicare, and private plans and expands Medicaid tobacco‑cessation coverage to all enrollees; funds outreach and a GAO study.
Official title: 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 May 19, 2026 by Richard Joseph Durbin · Last progress May 19, 2026
Requires annual lung cancer screening coverage without cost-sharing or prior authorization across Medicaid, Medicare (Part B and Medicare Advantage), and private group/individual plans when recommended by USPSTF or HHS guidelines, and expands Medicaid coverage of tobacco‑cessation counseling and pharmacotherapy to all enrollees. Directs HHS to run a targeted outreach campaign (authorized $10M/year FY2028–2032) and orders a GAO study on screening and diagnosis gaps; most coverage and prior‑authorization changes take effect January 1, 2028, with delayed compliance safe‑harbors for states that need legislative action.