Sponsors (2)
The bill expands and standardizes Medicaid coverage for breast cancer screening and follow-up exams—improving access for low-income women—while increasing state Medicaid costs and introducing potential limits on individualized clinical discretion.
Medicaid-enrolled women gain no-cost access to diagnostic and supplemental breast exams, reducing out-of-pocket barriers to follow-up care and likely improving timely diagnosis and outcomes.
Screening mammography with USPSTF grade A/B becomes a required Medicaid benefit, increasing preventive breast cancer screening coverage for low-income women.
Tying medical necessity for diagnostic/supplemental exams to NCCN guidelines promotes more consistent, standardized coverage decisions across states and providers, reducing arbitrary denials.
States will face increased Medicaid costs to provide additional no-cost services, creating budgetary pressure that could force tradeoffs or higher state spending.
State Medicaid agencies and providers will incur short-term administrative, compliance, and billing burdens to implement the new coverage requirements.
Narrowly tying medical necessity to NCCN guidelines could limit coverage in cases where guideline interpretation differs or individualized clinical judgment would support services, potentially restricting access for some patients.
Based on analysis of 2 sections of legislative text.
Requires Medicaid to cover diagnostic, supplemental, and USPSTF A/B screening mammography without any cost sharing and ties medical necessity to NCCN guidelines.
Official title: To amend title XIX of the Social Security Act to require that diagnostic and supplemental breast examinations are furnished without cost sharing under the Medicaid program, and for other purposes.
Introduced May 11, 2026 by Greg Landsman · Last progress May 11, 2026
Requires Medicaid to cover diagnostic and supplemental breast examinations without any enrollment fees, premiums, deductibles, cost sharing, or similar charges, and makes screening mammography rated A or B by the USPSTF a mandatory Medicaid benefit. The bill defines the added services, ties medical necessity for diagnostic/supplemental exams to National Comprehensive Cancer Network guidelines, and phases in the requirement to take effect for care furnished one year after enactment.