March 04, 2016

MediCal Again Covers Screening Mammo at 40

At the urging of the California Radiological Society, the California Department of Health Care Services (DHCS) has dropped its brief support for screening mammography beginning at 50 for patients covered by Medi-Cal, the state’s low-income health insurance program, in favor of annual screenings beginning at 40.

In mid-February, Medi-Cal announced that effective March 1, women under age 50 would not be eligible for screening mammography unless they submitted a Treatment Authorization Request (TAR), which overrides age and gender restrictions. . The new policy was intended to bring Medi-Cal in line with the latest U.S. Preventive Services Task Force breast cancer imaging recommendations favoring screening mammography beginning at 50 for most women.

Medi-Cal’s mammography-at-50 coverage policy alarmed many of California’s medical providers, including family physicians, ob-gyns and breast health specialists. The California Radiological Society and ACR staff were in frequent contact with other breast cancer screening advocates to urge DHCS to reverse the decision or delay its implementation. The stakeholders also planned to meet with DHCS in person to outline their concerns.

Without further consultation, the DHCS decided on March 1 to revert to the coverage policy for mammography beginning at 40 to the relief of the medical community. To justify the change, the state health services department revisited the “Consolidated Appropriations Act 2016” (CAA) Sec. 229, signed on December 18, 2015, and determined that under the CAA , from November 1, 2015 until January 1, 2018, any current USPSTF recommendation with respect to breast cancer screening, mammography, and prevention shall be administered as if such reference were to the recommendations last issued before 2009. Because the USPSTF’s recommendations uses the 2002 recommendation on breast cancer screenings beginning at age 40 and older, the department will revise the Medi-Cal policy, reverting it back to the policy that allowed breast cancer screenings beginning at age 40. Providers will be informed via a Medi-Cal NewsFlash and its provider bulletin to be released this week.