DHHS outlines costs and medical‑necessity test for Medicaid biomarker coverage; advocates press for earlier access

Sen. Regina Bersa, sponsor of SB 606, said the bill would require Medicaid to cover biomarker testing when the program determines a test is medically necessary. Dr. Jonathan Ballard, DHHS chief medical officer, reviewed the federal requirement that state Medicaid programs apply a medical‑necessity standard before federal matching funds can be used.

Dr. Ballard said thousands of biomarker tests exist but only a subset change clinical management. The department used an external list (Florida's review) of roughly 942 tests that do change care and directed its actuary to estimate fiscal exposure; Henry Litman, Medicaid director, presented a state share estimate of roughly $170,000 to $600,000 annually depending on uptake and per‑member impacts.

Patient advocates from the American Cancer Society and the Alzheimer's Association urged the committee to pass the bill to expand timely access to precision medicine and to reduce downstream costs from delayed diagnosis. "Timely access to guideline‑indicated comprehensive biomarker testing will enable more patients to access the most effective treatments," said Michael Rolo of the American Cancer Society.

Lawmakers questioned who would define medical necessity and how the department would manage prior‑authorization timelines. DHHS said medical necessity determinations are made by Medicaid clinical staff and that providers may request individual coverage when a test is not in a predefined covered list.

The committee closed the hearing with DHHS offering to work with sponsors on definitional language and cost contingencies before any final vote.