State Medicaid programs must do more to make sure that people at high risk for lung cancer are screening for the deadly disease. Medicaid is the public assistance program offering health care coverage for low-income Americans. Medicaid coverage for screening high-risk people varies widely between states: 31 Medicaid fee-for-service programs cover screening; 12 programs do not provide coverage; seven states did not have information available on their coverage policy.
In addition, eligibility criteria used for screening varied by state; as did whether prior authorization was required. “Lung cancer is the quiet killer; as it has few early symptoms and is oftentimes caught too late,” American Lung Association President and CEO Harold Wimmer said in an association news release. “Coverage for screening with low-dose CT is critical; this analysis will advance our work to ensure those eligible with state Medicaid coverage have access to this lifesaving screening.
The lung cancer screenings
The American Lung Association has partnered with the University of Texas MD Anderson Cancer Center on educational initiatives to improve coverage for recommended lung cancer screenings in state Medicaid programs. “Our mission at MD Anderson is to end cancer, and they know that the best way to do this is through cancer prevention and early detection,” said Dr. Peter Pisters, president of MD Anderson.
“Evidence-based screening is vital for those at high risk to ensure that lung cancer when it’s present; is detecting as early as possible. These actions must also complement our efforts in tobacco prevention and cessation; through which we could eliminate the vast majority of lung cancers,” Pisters said. Therefore lung cancer screening, which is by the U.S. Preventive Services Task Force (USPSTF), is covered as a preventive service at no cost by most private health insurance plans as well as by Medicare.
The major risk of lung cancer
However, state Medicaid programs are not to cover the screening or can offer coverage with significant barriers. Coverage of screening is especially important for Medicaid clients because 26.3 % of them are current smokers; which is a major risk for lung cancer. Therefore the USPSTF defines those at high risk of lung cancer as people aged 55 to 80 who have a 30 pack-year history of smoking and currently smoke or have quit smoking within the past 15 years.
Pack-year is a unit of measuring how much a person smokes over time. For example, a person who smokes a pack a day for 30 years has a 30 pack-year history. In conclusion, If all high-risk people screened, about 25,000 lives would be saved; according to the American Lung Association.