Sponsors (2)
The bill expands Medicaid coverage for breast cancer screening and follow-up to reduce financial barriers and improve early detection for beneficiaries (primarily women), at the cost of increased state Medicaid spending and potential limits on individualized coverage when care is narrowly tied to guideline criteria.
Medicaid beneficiaries, especially women, gain mandatory coverage of USPSTF A/B screening mammography plus no-cost diagnostic and supplemental breast exams for follow-up care, reducing out-of-pocket barriers and likely improving timely detection and outcomes.
Hospitals, health systems, and state Medicaid programs get clearer, standardized criteria for when diagnostic/supplemental breast exams are medically necessary by tying coverage decisions to NCCN guidelines, which can reduce inconsistent coverage decisions and support consistent clinical decision-making.
State governments and taxpayers will face higher Medicaid costs to cover the expanded, no-cost screening and follow-up services, creating budgetary pressure and potential tradeoffs in other state spending or revenue decisions.
Tying medical necessity to NCCN guidelines could restrict coverage in cases where guidelines don’t fit individual clinical situations, potentially limiting clinicians' discretion and leaving some patients without recommended care.
State Medicaid agencies and providers will incur short-term administrative and billing compliance burdens to implement the coverage changes, requiring system updates and training.
Based on analysis of 2 sections of legislative text.
Requires Medicaid to cover diagnostic and supplemental breast exams and USPSTF A/B screening mammography without any premiums, enrollment fees, deductibles, or cost sharing.
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, and makes screening mammography with a USPSTF grade A or B a mandatory Medicaid benefit, all without premiums, enrollment fees, copayments, deductibles, or other cost sharing. Defines the added services and ties medical necessity for diagnostic/supplemental exams to National Comprehensive Cancer Network (NCCN) guidelines. The changes amend federal Medicaid statutes and phase in one year after enactment so that medical assistance furnished on or after that date must follow the new coverage and cost-sharing rules.