Friday, September 24, 2021

Michigan Medicaid Proposes Rules to Reimburse Whole Genome Sequencing

Tucked inside a presentation on September 13, 2021, by Illumina's CEO Francis deSouza, a remark that points to new genomic test coverage at Michigan MedicaidHere's the speech (at Morgan Stanley).

"We have teams that now have deep expertise and experience and tools in getting reimbursement.We saw that even recently where last week Michigan became the first state in the US to have Medicaid coverage for critically-ill children in the NICU for rapid whole genome sequencing. That work on a project called Project Baby Bear [a California Medicaid project for pediatric genomics] was something that we'd worked on for a couple of years to make that happen."

There's a story about Michigan Project Baby Deer (pediatric genomics) at the Rady Children's Institute Genomic Medicine website, here:

"On September 1, 2021, Michigan became the first state to make rapid Whole Genome Sequencing™ a covered benefit for eligible infants enrolled in Medicaid (contingent upon approval of a State Plan Amendment [SPA] by the Centers for Medicare & Medicaid Services).  Michigan Medicaid will reimburse hospitals for the cost of rWGS testing separate from inpatient DRG payments."

See the original Michigan policy document PDF, dated August 17, 2021, here:

See the PDF for inclusion and exclusion rules.  

See an NPR story on infant WGS, October 2019, here.  See a long-form story by Michele Marrill in Wired, March 2020, here.  See a story in MedPageToday, June 2021, here.

For more about the California "Baby Bear" clinical whole genome sequencing project, website at Rady, here.   For a peer-reviewed article on Project Baby Bear, July 2021, Amer J Hum Genet (Dimmock et al), here.  (I noticed this article is online at SciHub).  See also Rady authors at Franck et al., 2021, adoption barriers, here.    (But see Lantos op ed, here.)   For an archive of Grand Rounds videos from Rady, here.

In the U.S. Senate, S.2022 is one of several pieces of legislation in the past year to address increased coverage of urgent pediatric genomic tests in Medicaid.


On biomarkers more generally.  I'm not versed in the details, and legislation can be variably easy or hard to read, but this year Illinois passed a biomarker coverage law (see Genomeweb, August 2021, Turna Ray, here) and so did Louisiana.  In California a Biomarker Bill, SB-535, passed the assembly September 2 and the Senate September 7 - here.


See Rady's webpage for pediatric genomic projects by state.  California has had Baby Bear; Michigan, Baby Deer; Florida, Baby Manatee, and so on.