No-Cost Breast Examinations in Medicaid Act of 2026
- Sponsor
- Rep. Landsman, Greg [D-OH-1]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- May 11, 2026
Bottom line
This bill aims to eliminate financial barriers to breast cancer detection for Medicaid beneficiaries by ensuring diagnostic, supplemental, and screening mammography examinations are fully covered without out-of-pocket costs.
What it actually does
This bill amends the Social Security Act to prohibit cost-sharing for diagnostic and supplemental breast examinations under the Medicaid program. It also mandates that screening mammography, as defined by Medicare and graded A or B by the U.S. Preventive Services Task Force, be included as a mandatory benefit under Medicaid. The changes are set to apply one year after enactment.
Proponents argue
Supporters argue this bill will significantly improve health outcomes for low-income individuals by removing financial deterrents to crucial breast cancer screenings and diagnostics, leading to earlier detection and more timely treatment. They emphasize that even small cost-sharing requirements can disproportionately affect vulnerable populations, delaying necessary care and exacerbating health disparities.
Opponents contend
Critics might argue that while the intent to improve access is commendable, mandating additional benefits and eliminating cost-sharing without a clear, dedicated federal funding mechanism could increase state Medicaid burdens or federal expenditures. This could potentially strain existing healthcare budgets or necessitate trade-offs in other program areas.
The bill is very short and its core provisions are easily understandable, allowing for quick evaluation by an informed reader.
Section 2(a)
No Cost-Sharing for Diagnostic and Supplemental Breast Exams
This provision amends sections 1916 and 1916A of the Social Security Act to explicitly prohibit states from imposing any cost-sharing, such as co-payments, deductibles, or premiums, on Medicaid beneficiaries for diagnostic and supplemental breast examinations. This ensures that individuals needing these critical tests will not face out-of-pocket expenses at the point of service.
Supporters argue
Supporters argue that eliminating cost-sharing will significantly increase access to critical diagnostic services, leading to earlier detection of breast cancer and improved treatment outcomes for Medicaid recipients. They highlight that even small co-pays can be a substantial barrier for low-income individuals, delaying necessary medical attention.
Critics contend
Some might argue that while beneficial for beneficiaries, this provision could increase federal and state Medicaid expenditures, potentially impacting overall budget flexibility or requiring trade-offs in other program areas, especially if utilization significantly increases.
Tradeoffs
The primary tradeoff is between ensuring equitable access to life-saving diagnostic care by removing financial barriers and the potential increase in program costs for states and the federal government, which must be managed within existing budgetary frameworks.
Section 2(b)
Standardized Definitions for Breast Examinations
This section adds a new subsection (ll) to Section 1905 of the Social Security Act, establishing federal definitions for 'diagnostic breast examination' and 'supplemental breast examination.' These definitions specify that such examinations must be medically necessary and appropriate according to National Comprehensive Cancer Network Guidelines, encompassing various imaging techniques like mammography, MRI, and ultrasound for evaluating abnormalities or screening high-risk individuals.
Section 2(c)
Mandatory Coverage for Screening Mammography
This provision amends sections 1902(a)(10)(A) and 1905(a)(13) of the Social Security Act to make screening mammography a mandatory benefit under Medicaid. Specifically, it requires coverage for screening mammography (as defined in section 1861(jj) of the Act, which relates to Medicare) that has been assigned a grade of A or B by the United States Preventive Services Task Force.