Some Californians who may be helped by genetic tests are having a hard time getting them because the state's Medi-Cal program, its version of Medicaid, will not cover some tests that are reimbursed by other states, according to SFGate.
The issue stems from Medi-Cal's 2001 decision to stop accepting new medical service providers, a move it made at the time to avoid fraud but which now has led many poor children with potentially serious health issues to be denied certain tests, SFGate's Jessica Carew Kraft reports. The tests Medi-Cal will not pay for include tests to identify myscular dystrophy, epilepsy, hereditary cancer, cardiac defects and a range of other syndromes, she writes.
Kraft points out that Medi-Cal's coverage rules are "at odds with federal guidelines," and cites an agency spokesman as saying the moratorium is part of the problem.
"In an especially befuddling paradox, Medi-Cal does cover prenatal testing for conditions like Down syndrome, and screening of newborns for conditions like cystic fibrosis, but it won't pay to screen potential parents for these same genetic conditions before conception or to diagnose an older child," she writes.
Bryce Mendelsohn, of the University of California, San Francisco Benioff Children's Hospital, estimates that lack of access to testing is impacting at least 2,000 California families on Medi-Cal each annually.
"If a patient has private insurance, we talk about what testing would be most appropriate, even very advanced tests. If they are poor and on Medi-Cal, we counsel and educate, but we know we could be doing more," Mendelsohn says.