Health care coverage: home test kits

The law expands access to cervical cancer screening by allowing eligible patients to collect samples outside a clinical setting. It adds the benefit to commercial health coverage and Medi-Cal, subject to applicable requirements.

What the law does ​

• Requires most health plans and insurance policies to cover provider-ordered or provided cervical cancer screening consistent with State Department of Public Health recommendations.
• Requires coverage to include conventional Pap tests, FDA-approved human papillomavirus tests, and FDA-authorized or cleared self-collected screening kits for use outside clinical settings.
• Bars deductibles, copayments, coinsurance, and other cost sharing for covered screening, subject to federal high-deductible health plan rules for health savings account-eligible coverage.
• Makes provider-ordered FDA-authorized or cleared home screening kits a Medi-Cal benefit in fee-for-service and managed care, subject to medical-necessity, utilization-management, federal-approval, and federal-funding conditions.
• Excludes vision-only, dental-only, Medicare supplement, and specialized health plan coverage from the commercial-plan requirement.

Who it affects ​

• Enrollees in most individual and group health plans and health insurance policies.
• Medi-Cal beneficiaries whose providers order eligible home cervical cancer screening kits.
• In-network health care providers ordering or providing cervical cancer screening.
• Health plans, insurers, and Medi-Cal delivery systems.

Context ​

The law takes effect for the new screening-coverage requirements on January 1, 2027.

Breakdown ​

Cervical Cancer Self-Collection Coverage ​

Starting January 1, 2027, most health plans and insurance policies must cover cervical cancer screening without charging patients cost sharing. This includes FDA-authorized or cleared self-collected cervical screening kits when an in-network provider orders or provides them and the screening follows State Department of Public Health recommendations. Vision-only, dental-only, and Medicare supplement coverage are excluded.

Key takeaways

• The bill expands required cervical cancer screening coverage to include eligible self-collected screening kits.
• Patients cannot be charged deductibles, copayments, coinsurance, or other cost sharing for covered screening.
• Coverage applies when an in-network provider orders or provides the screening and it follows specified state public health recommendations.
• The requirement applies to contracts and policies issued, amended, or renewed on or after January 1, 2027.
• Health savings account-eligible coverage is subject to the requirement only to the extent it is a federally defined high-deductible health plan.
• A willful violation by a health care service plan can be prosecuted as a crime under existing law.

Medi-Cal Cervical Cancer Screening ​

Starting January 1, 2027, Medi-Cal will cover cervical cancer screening tests ordered by a patient’s health care provider when they follow state public health recommendations. It will also cover FDA-authorized or cleared at-home cervical cancer test kits ordered by a provider, with no cost sharing, if federal funding and required federal approvals are available.

Key takeaways

• The bill changes Medi-Cal coverage from physician-referred annual cervical cancer testing to provider-ordered cervical cancer screening that follows specified state recommendations.
• Beginning January 1, 2027, Medi-Cal must cover qualifying cervical cancer screening tests ordered by a patient’s health care provider.
• Beginning January 1, 2027, Medi-Cal must also cover qualifying FDA-authorized or cleared home test kits for cervical cancer screening.
• Home test kits must be ordered by a patient’s health care provider and comply with state public health recommendations and Medi-Cal policies.
• Covered home test kits must be provided without cost sharing, subject to available federal financial participation and required federal approvals.

No State Reimbursement Required ​

The bill states that the state does not have to reimburse local agencies or school districts for costs related to this act. It relies on a specified reason for concluding that reimbursement is not required.

Key takeaways

• The bill says local agencies and school districts are not entitled to state reimbursement for costs imposed by this act.
• California generally reimburses local governments and school districts for certain state-required costs.
• The bill identifies a specified reason why reimbursement is not required.