The United States Preventive Services Task Force (USPSTF) is a 16-member panel of experts that receives administrative, research, and technical support from the federal Agency for Healthcare Research and Quality.  The USPSTF makes recommendations on clinical preventive services on a graded scale.  Under the federal Affordable Care Act, Medicaid expansion plans must cover preventive care services given an A or B rating by the USPSTF and traditional Medicaid plans that elect to cover those services receive a 1 percent increase in their federal matching funds for those services.
 
There are two main types of colorectal cancer screening tests, stool-based tests, and direct visualization tests.  Stool-based tests may either identify blood in the stool or cancer biomarkers shed from the lining of the colon in the stool to detect cancer.  Direct visualization tests view the inside of the colon and the rectum through various methods, including colonoscopy, computerized tomography colonography, and flexible sigmoidoscopy.  The USPSTF gives both types of colorectal cancer screenings an A rating for adults aged 50 to 75 years and a B rating for adults aged 45 to 49 years.

Colorectal cancer is the third leading cause of cancer death for both men and women in the United States. Colorectal cancer is most frequently diagnosed among persons aged 65 to 74 years.

Beginning January 1, 2024, the Health Care Authority must require coverage under medical assistance programs for noninvasive preventive colorectal cancer screening tests that have a USPSTF grade of either A or B, and to require coverage for colonoscopies performed as a result of a positive test result.

PRO: Colon cancer is the second leading cause of cancer deaths in Washington but the state is only screening about 62 percent of eligible patients.  Consistent adherence to screening recommendations is the key to keeping costs down and improving patient outcomes. This bill has the double benefit of reducing costs and increasing utilization since at-home tests are less invasive and cheaper than a colonoscopy. Giving patients the choice of different screening modalities will also help as early detection and early treatment would eliminate death. This bill expands access to screenings and this bill will eliminate barriers that allow patients with a positive screening to receive colonoscopies. Patients covered by Medicaid are significantly more likely to be diagnosed with a late stage cancer than patients with private insurance. Many patients do not follow up for colonoscopies after a positive screening because patients fear the cost of the follow-up colonoscopies.  This leads to patients prolonging treatment with potentially curable cancer and ending up with incurable cancer.

PRO: Colon cancer is the second leading cause of death in Washington. There are 3000 new cases a year and 1000 deaths. People delay screenings because of the discomfort of colonoscopies. Providing more non-invasive options will improve patient outcomes. This will also help keep costs down by catching cancer early. This aligns with private insurance and promotes access to screening and care.