Improving Medicaid Precision and Cancer Test Act of 2025

Bill Number

H.R. 6320

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-11-28: Referred to the House Committee on Energy and Commerce.

Last Updated

2026-02-04T09:06:48Z

AI-Generated Summary

Purpose

The "Improving Medicaid Precision and Cancer Test Act of 2025" (H.R. 6320) aims to expand access to advanced diagnostic testing for lung cancer among low-income individuals by mandating coverage under the Medicaid program. It focuses on "biomarker testing," which involves analyzing biological markers in a patient's tumor to guide personalized treatment decisions, such as identifying specific genetic mutations that can be targeted with therapies.

Key Provisions

• Mandatory Coverage Addition: Requires all state Medicaid programs to cover lung cancer biomarker testing as a medical assistance benefit.
• Specific Amendments to the Social Security Act:
• Updates Section 1902(a)(10)(A) to include biomarker testing as one of the required services states must provide to eligible individuals.
• Adds a new paragraph (32) to Section 1905(a), explicitly listing "lung cancer biomarker testing" as a covered service alongside other medical benefits like hospital care and prescription drugs.
• Modifies Section 1937(b)(5) to ensure benchmark coverage plans (alternative Medicaid options) include this testing starting January 1, 2027.
• Effective Date: The changes take effect on January 1, 2027, giving states time to implement the requirement.

Significant Changes to Existing Law

• Prior to this bill, Medicaid covered a broad range of services but did not explicitly mandate coverage for lung cancer biomarker testing, leaving it to state discretion. This legislation makes it a required benefit nationwide, similar to how it mandates coverage for other screenings and treatments.
• It redesignates an existing paragraph in the law (from 32 to 33) to insert the new provision, ensuring seamless integration without disrupting other benefits.

Potential Impacts

• On Citizens: Low-income individuals diagnosed with lung cancer (Medicaid's primary beneficiaries, often including those with disabilities or low earnings) will gain guaranteed access to biomarker testing, potentially leading to earlier, more targeted treatments and improved health outcomes. This could reduce overall healthcare costs by avoiding ineffective therapies.
• On Government Agencies: State Medicaid programs will need to update their coverage policies, train providers, and budget for additional costs, with federal matching funds covering a portion (typically 50-78% depending on the state). The Centers for Medicare & Medicaid Services (CMS) may issue guidance to ensure uniform implementation.
• On International Relations: No direct impact, as this is a domestic health policy focused on U.S. public insurance.

Main Stakeholders Affected

• Medicaid Beneficiaries: Particularly those with lung cancer, who may include up to 10 million low-income Americans; this expands their access to precision medicine.
• Healthcare Providers: Oncologists, labs, and hospitals that perform biomarker testing will see increased reimbursements and utilization.
• State and Federal Governments: States bear implementation costs, while the federal government provides funding support and oversight.
• Pharmaceutical and Biotech Companies: Firms developing targeted cancer therapies may benefit from wider testing adoption, driving demand for their products.
• Advocacy Groups: Organizations focused on cancer research and patient rights, such as the American Lung Association, stand to gain from enhanced equity in care.

Notable Legal, Constitutional, or Political Implications

• Legal: Strengthens federal mandates on state Medicaid programs under Title XIX of the Social Security Act, potentially inviting challenges if states argue it imposes unfunded burdens (though federal matching funds mitigate this). It aligns with existing requirements for "medically necessary" services, promoting evidence-based care without altering eligibility rules.
• Constitutional: No apparent conflicts with federalism principles, as Medicaid already involves shared state-federal responsibilities; it upholds equal protection by ensuring uniform access to life-saving diagnostics across states.
• Political: Highlights bipartisan support (introduced by Representatives Gottheimer and Rutherford) for expanding precision medicine in public programs, potentially setting a precedent for mandating coverage of other biomarker tests in conditions like breast or colorectal cancer. It may influence debates on healthcare affordability and innovation amid rising cancer rates.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Gottheimer, Josh [D-NJ-5]

Cosponsors (3)

Rep. Rutherford, John H. [R-FL-5], Rep. Swalwell, Eric [D-CA-14], Rep. Grijalva, Adelita S. [D-AZ-7]

Recent Actions

• 2025-11-28: Referred to the House Committee on Energy and Commerce.
• 2025-11-28: Introduced in House
• 2025-11-28: Introduced in House

Bill Versions

• Improving Medicaid Precision and Cancer Test Act of 2025 — issued 2025-11-28 — PDF (2 pages)