Don’t Roll Back Medicaid Coverage for Lifesaving Biomarker Testing
Our lawmakers in Albany are currently considering a proposal that could leave patients with Medicaid with fewer and less effective treatment options than those covered through private insurance. The Executive Budget proposes to roll back Medicaid coverage criteria for biomarker testing, a critical tool that helps doctors match cancer patients with the treatments most likely to save their lives. This proposal could limit access to biomarker testing for millions of New Yorkers who rely on Medicaid, which would deepen inequities in our health care system and undermine progress in cancer care. With more than 125,000 New Yorkers expected to be diagnosed with cancer in 2026, the consequences of this decision could be both immediate and profound.
The state is undoubtedly facing difficult fiscal choices. Medicaid costs are rising, and federal funding uncertainty has placed added pressure on the state budget. But limiting access to biomarker testing erodes both patient health and the state’s long-term financial interests.
Two years ago, state lawmakers from both parties overwhelmingly passed legislation requiring equitable coverage of proven biomarker tests across Medicaid and state-regulated private insurance plans. When the legislation went to the Governor for her signature, she didn’t just sign it, she insisted on strengthening it. This was a landmark victory for health equity, ensuring that the type of insurance a patient carried would not determine whether they could access precision medicine, which connects patients to the most advanced, targeted care for diseases like cancer and other complex illnesses.
The Executive Budget proposal threatens to undo that progress. By eliminating established Medicaid coverage criteria while leaving private insurance protections intact, the proposal fractures the consistency that allows providers to deliver equitable, evidence-based care across payors.
Biomarker testing helps clinicians identify the right treatment at the right time. Research shows that biomarker-informed cancer treatments can improve outcomes, extend survival and, for many patients, significantly enhance quality of life. When providers are forced to rely on trial-and-error approaches, patients may spend months, or years, on ineffective therapies. In diseases like rheumatoid arthritis, those delays allow irreversible damage. In cancer, delays can be deadly.
Worse still, denying patients access to biomarker testing is not the cost saving measure some might assume. Ineffective treatments, unnecessary side effects, repeated hospitalizations and avoidable complications all drive up costs for Medicaid. Precision medicine, by contrast, can help prevent wasted spending on therapies that are unlikely to work. When the state is searching for efficiencies, eliminating a tool that reduces waste makes little fiscal sense.
New York should be proud of the progress it has made toward equitable access to precision medicine. Lawmakers recognized then that no patient, regardless of income, race, ethnicity or ZIP code, should be denied the most advanced treatment options simply because their insurance card looks different. Rolling back that promise now could widen health disparities at a moment when we should be closing them.
We stand ready to work with the state to find real solutions to any challenges that implementing this law may have posed. But those solutions cannot come at the cost of patients’ care and quality of life. The Legislature must protect the bipartisan gains it achieved in 2023 and ensure that Medicaid enrollees continue to receive equitable coverage for evidence-based biomarker testing that has helped transform how we treat disease.
The Executive Budget proposal should not appear in the one house budgets, nor in the final state budget. Too much is at stake, for patients, for families and for the state’s commitment to health equity.
Michael Davoli is Senior Government Relations Director, ACS CAN New York.
