Increasing Access to Lung Cancer Screening Act
- Sponsor
- Rep. Castor, Kathy [D-FL-14]
- Committees
- Ways and Means Committee (primary)
- Last action
- Nov 20, 2025
Bottom line
This bill aims to significantly increase access to lung cancer screening and tobacco cessation services across Medicaid, Medicare, and private insurance by eliminating cost barriers and prior authorization requirements, alongside a public awareness campaign.
What it actually does
This bill mandates Medicaid coverage for annual lung cancer screenings with no cost sharing for individuals recommended by U.S. Preventive Services Task Force (USPSTF) guidelines, and expands Medicaid coverage for tobacco cessation counseling and pharmacotherapy to all eligible individuals, removing the prior limitation to pregnant women. It also prohibits prior authorization for lung cancer screenings under Medicare and private health insurance, and authorizes funding for a federal education and outreach campaign on lung cancer screening.
Proponents argue
Proponents argue this bill will save lives by detecting lung cancer earlier, improving health outcomes, and reducing healthcare costs in the long run by shifting from late-stage treatment to early intervention. Expanding tobacco cessation services will also address a primary cause of lung cancer and other diseases, further promoting public health and reducing health disparities.
Opponents contend
Potential opponents might raise concerns about the increased federal and state costs associated with expanding mandated coverage and the administrative burden on states and insurers. Some may argue against federal mandates on state Medicaid programs or private insurers, or express concerns that removing prior authorization could lead to overutilization or inappropriate screenings.
The bill is relatively short and clearly written, making it accessible for a quick review by interested parties.
Section 2(a), amending Section 1905(a)(4) of the Social Security Act
Mandated Medicaid Coverage for Annual Lung Cancer Screening
This provision requires state Medicaid plans to cover annual lung cancer screenings for individuals for whom such screening is recommended by the U.S. Preventive Services Task Force (USPSTF) guidelines. This coverage must be provided without requiring prior authorization, ensuring direct access for eligible beneficiaries.
Supporters argue
Supporters argue this will lead to earlier detection, better treatment outcomes, and reduced mortality from lung cancer among a vulnerable population, aligning Medicaid with best preventive care practices and reducing long-term healthcare costs.
Critics contend
Critics might point to increased costs for state Medicaid programs, potentially requiring new state appropriations or reallocations, and the administrative burden of implementing a new mandatory benefit.
Tradeoffs
Balancing the significant public health benefit of early detection and improved outcomes against the immediate fiscal impact on state budgets and potential administrative adjustments.
Section 2(b), amending Section 1916 and 1916A of the Social Security Act
Elimination of Cost Sharing for Medicaid Lung Cancer Screening
This provision prohibits states from imposing any cost sharing, such as co-payments or deductibles, for annual lung cancer screenings covered under Medicaid. This includes for those plans utilizing alternative cost-sharing structures, thereby removing financial barriers for eligible individuals.
Section 2(c), amending Section 1932(b) of the Social Security Act
Managed Care Organization Requirements for Lung Cancer Screening
This provision mandates that contracts between states and Medicaid managed care organizations (MCOs) must require MCOs to provide coverage for annual lung cancer screenings without prior authorization. This ensures that beneficiaries enrolled in managed care plans receive the same access to screening as those in fee-for-service Medicaid.
Section 3(a), amending Section 1905(a)(4)(D) and 1905(bb) of the Social Security Act
Universal Medicaid Coverage for Tobacco Cessation Services
This provision expands mandatory Medicaid coverage for counseling and pharmacotherapy for tobacco cessation to all Medicaid-eligible individuals, removing the current limitation that primarily covers only pregnant women. It also specifies that this coverage must be provided without prior authorization, making it more accessible.
Section 4(a), amending Section 1834 and 1852(a)(1)(B) of the Social Security Act
Prohibition of Prior Authorization for Medicare Lung Cancer Screening
This provision prohibits the application of prior authorization requirements for annual lung cancer screenings covered under Medicare Part B and Medicare Advantage plans. This applies to individuals for whom such screening is recommended by Secretary-issued guidelines, aiming to remove administrative hurdles.
Section 4(b), amending Section 2713 of the Public Health Service Act
Prohibition of Prior Authorization for Private Health Insurance Lung Cancer Screening
This provision prohibits group health plans and health insurance issuers offering group or individual coverage from imposing prior authorization requirements for annual lung cancer screenings recommended by the USPSTF. This extends the no-prior-authorization rule to the private insurance market.
Section 5
Federal Education and Outreach Campaign for Lung Cancer Screening
This section directs the Secretary of Health and Human Services (HHS) to conduct an education and outreach campaign, in consultation with patient and advocacy groups. The campaign's purpose is to inform individuals and healthcare providers about the importance of lung cancer screenings and the categories of individuals who should receive them, specifically targeting high-risk individuals.
Section 6
GAO Report on Lung Cancer Demographics and Screening Gaps
This section requires the Comptroller General of the United States to conduct a study and submit a report to Congress within one year of the Act's enactment. The report must identify demographics of individuals diagnosed with lung cancer and those screened, specifically looking for populations diagnosed but not covered by current screening guidelines (e.g., firefighters, veterans, women under 50), and recommend federal actions to improve screening for these segments.
These clauses provide an exception to the January 1, 2026 effective date for states that require state legislation (other than appropriations) to implement the new Medicaid requirements. Such states would have until the first calendar quarter after the close of their first regular legislative session following the Act's enactment.
Section 2(d)(2) and Section 3(d)(2)
Why it matters:This is standard legislative practice to accommodate states with varying legislative calendars and processes, ensuring feasibility of implementation without immediately penalizing states for legislative delays.
Case for: Allows states adequate time to adjust their laws and budgets, preventing immediate non-compliance and potential legal challenges, thereby ensuring a smoother transition to the new requirements.
Case against: Delays the full implementation of expanded coverage in some states, potentially creating a patchwork of access across the country for a period, which could exacerbate health disparities.
Estimated impact: Could delay access to lung cancer screening and tobacco cessation services for millions of Medicaid beneficiaries in certain states for up to two years, depending on state legislative cycles.
These subsections make conforming amendments to Medicaid cost-sharing rules (Sections 1916 and 1916A) to explicitly exempt tobacco cessation counseling and pharmacotherapy from cost-sharing requirements for all individuals, not just pregnant women.
Section 3(b), particularly subsections (2) and (3), amending Sections 1916 and 1916A
Why it matters:This is standard legislative practice to ensure consistency across related statutory provisions when a primary section is amended, making sure the intent of the main policy change is fully realized.
Case for: Ensures that the intent of universal, no-cost tobacco cessation coverage is fully realized by explicitly removing cost-sharing barriers, which are known deterrents for vulnerable populations.
Case against: No specific opposition to these technical conforming amendments, as they simply align with the main policy change to expand tobacco cessation coverage without cost-sharing.
Estimated impact: Reinforces the no-cost-sharing policy for all Medicaid beneficiaries seeking tobacco cessation, removing potential financial hurdles and ensuring equitable access to these services.