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From State to State

Although new genetic tests may enable people to take preventive steps to address their cancer risks, just how useful those tests are may depend on which state you live in, Slate reports.

Because of the "patchwork of coverage" for genetic testing, counseling, and follow-up preventive tests in the US, a genetic predisposition for cancer "can either be a death sentence or a guide to proper preventive care," Slate's Jeanne Erdmann writes.

For example, even if a woman's insurance pays for a test for genetic risk for breast cancer, her state's Medicaid program may not cover mammograms that are necessary to monitor her health afterwards, or genetic counseling to help interpret what her test means.

The Affordable Care Act may be a partial remedy, as it does cover genetic testing and should make them less expensive for some people, and mandates that no cost-sharing can be charged for genetic tests. But any related counseling and follow-up care will be worked out by individual insurance providers. For people on Medicaid, the states will determine what is covered.

Erdmann says Missouri typifies the genetic counseling situation in many states. While the state covers genetic testing under its Medicaid program, any follow-up counseling and care is covered on a case-by-case basis.

"Genetic counselors say they rarely win a case. These disparities hit women hard," she writes, explaining that in states like Missouri women on Medicaid are in a "treatment bind. A positive result on a genetic test is not considered a diagnosis in Missouri, so women play a risky game of “watchful waiting."