States Fight for Medicaid Coverage of Routine Care Costs for Clinical Trials

June 23, 2020

The Association for Clinical Oncology (ASCO) continues to advocate for federal and state legislative action to guarantee Medicaid coverage of routine care costs (like laboratory tests and physician visits) for clinical trial participants. Medicaid is the only major insurer that is not required to cover these costs, which means that patients with life-threatening conditions do not have access to the best – and sometimes only—treatment option for their condition.

Recently three states made important progress to expand this clinical trial coverage through Medicaid: 

ASCO and the Rocky Mountain Society (RMOS) supported CO HB 1232, which was spearheaded by the Colorado Cancer Caucus with the support of the Lieutenant Governor. RMOS Board member Dr. Alan Miller testified in support of HB 1232 before the House Health and Insurance Committee on March 3 for RMOS and ASCO. CO HB 1232 passed June 3 in the Senate after House passage on May 27.

In Illinois, ASCO and the Illinois Medical Oncology Society (IMOS) supported IL SB 2499 as part of a coalition of organizations. IMOS Board member Dr. Blase Polite testified in support of the bill for IMOS and ASCO before the Senate Human Services Committee on February 5 and spoke at a press briefing on SB 2499 on February 12. The policy passed the General Assembly as part of an omnibus package on May 26.

Similarly, ASCO and the Minnesota Society of Clinical Oncology (MSCO) supported MN SF 3125/HR 3026 along with other stakeholders. It passed May 23 as part of an omnibus and was signed into law on May 27.

Once the Colorado and Illinois laws are signed by their respective Governors, 15 states plus the District of Columbia will have laws requiring Medicaid coverage of the routine care costs of clinical trials for enrollees with a life-threatening condition.

Other states also continue to make progress.  

The Hawaii Society of Clinical Oncology (HSCO) held a successful meeting with Hawaii Medicaid, which resulted in the Hawaii Department of Health releasing guidance that Medicaid would cover the routine care costs of clinical trials participation in December 2019.

ASCO developed resources, including an infographic, to help stakeholders further understand this important issue.

ASCO members are encouraged to use the ASCO ACT Network to express their support for H.R. 913, the CLINICAL TREATMENT Act, which would federally guarantee coverage of routine care costs for patients with life-threatening conditions enrolled in Medicaid.

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