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SB 3668

MEDICAID-MAMMOGRAPHY

104th Regular Session Introduced by Mattie Hunter and 3 co-sponsors

Expands Illinois Medicaid to cover screening and diagnostic mammography starting at age 25, adds quality panels, and funds patient navigation and breast cancer support programs.

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Bill Summary · SB 3668

Summary of SB3668 (104th Illinois General Assembly)

Title: MEDICAID-MAMMOGRAPHY

Status: Introduced February 5, 2026. Assigned to Appropriations — Health and Human Services. Pending committee actions and potential amendments.

Effective date: Immediate upon becoming law.

Jurisdiction: Illinois

Primary sponsor: Senator Adriane Johnson
Co-sponsors: Senators Mike Simmons, Mattie Hunter, Karina Villa

1) Purpose and Intent

SB3668 amends the Medical Assistance article of the Illinois Public Aid Code to expand and enhance Medicaid coverage and services related to breast health, mammography, and breast cancer care. Major aims include:
- Lowering the age at which screening mammography for occult breast cancer is covered (from 35 to 25 years old).
- Establishing expert panels to set quality standards for mammography and breast cancer treatment.
- Aligning payment and rate methodologies with quality standards and recognized imaging centers.
- Creating pilot and then permanent patient navigation and financial assistance programs for beneficiaries diagnosed with breast cancer.
- Improving outreach to age-appropriate women who have not recently screened.
- Expanding training for radiologists and mammography staff.
- Providing broader breast health services and related preventive care (in the context of a broad Medicaid modernization).

2) Key Provisions and Changes

  • Mammography Coverage Expansion

    • Authorizes coverage for screening by low-dose mammography for occult breast cancer for individuals age 25 and older who are eligible for medical assistance.
    • Specifies coverage components, including:
    • Baseline mammogram for ages 25–39.
    • Annual mammogram for ages 40+ with no family history.
    • Mammograms for under-40 with risk factors (family history, prior breast cancer, genetic risk, etc.).
    • Comprehensive ultrasound and MRI when indicated (dense breast tissue, medically necessary).
    • Screening MRI when medically necessary.
    • Diagnostic mammography when medically necessary.
    • Molecular Breast Imaging (MBI) and MRI in certain cases.
    • Prohibits cost-sharing (deductibles, coinsurance, copays) for most screening/Diagnostic coverage, with a caveat for high-deductible health plans if it would disqualify an HSA.

  • Quality Standards and Expert Panels

    • Creates two expert panels (no more than 15 members) to review and establish:
    • Quality standards for mammography.
    • Quality standards for breast cancer treatment.
    • Panels to meet regularly (quarterly) and provide advisory input.

  • Rate Methodology Based on Standards

    • Requires that, with Department approval, the rate methodology for screening and diagnostic mammography be based on the standards established by the expert panels and State-qualified ACR Designated Comprehensive Breast Imaging Centers (formerly “Breast Imaging Centers of Excellence”).
    • Centers may collaborate with hospital-based facilities for rate setting.

  • Outreach and Education

    • Panels must develop a comprehensive methodology to inform age-appropriate women who have not had a mammogram in the last 18 months about the benefits of screening.
    • Establish a public-facing outreach/education program, working with a nonprofit organization (independent, not hospital-affiliated, and not Medicaid-reimbursed across multiple facilities) to provide navigation and outreach for uninsured/underinsured women.

  • Patient Navigation and Pilot to Permanent Program

    • Establish a pilot for case management or patient navigation for women diagnosed with breast cancer.
    • Within two years after pilot completion, establish the “Patient Assistance for Beneficiaries Diagnosed with Breast Cancer” as a permanent program, funding permitting.
    • Annual reporting to the General Assembly on outcomes, expenditures, and recommendations.

  • Training

    • Requires training and continuing education opportunities for radiologists and mammography technologists on breast health and imaging.

  • Additional Provisions (Broader Medicaid Reforms)

    • Several package provisions widen coverage for dental services, eye care, HPV vaccination, perinatal depression screening, newborn screening, opioid misuse treatment, and other reproductive/long-term care services (with federal approvals as needed).
    • Introduces or expands grant programs for safety-net facilities to upgrade mammography equipment and navigation services.
    • Encourages data sharing across state agencies for program integrity (with privacy considerations).
    • Establishes requirements for documentation, provider enrollment, and claims timing (with several long-standing administrative rules).

  • Other Notable Provisions

    • Require at least one Breast Imaging Center of Imaging Excellence in networks by 2016 (ACR designation context).
    • Require DME (durable medical equipment) accreditation for providers billing Medicaid.
    • Authorizes environmental and cost-saving measures, including refurbished equipment under certain conditions.
    • Includes a data-sharing framework with federal and state agencies for program integrity.

3) Who/What Is Affected

  • Beneficiaries: Medicaid enrollees in Illinois, particularly women and individuals at risk for breast cancer, who will gain expanded screening coverage, reduced cost-sharing for screenings, and access to diagnostic imaging when medically necessary.
  • Healthcare Providers: Radiologists, mammography centers, hospitals, and clinics participating in Medicaid; they face updated rate methodologies, training requirements, and potential participation in expert panels.
  • Public Health/Administrators: Illinois Department of Healthcare and Family Services (HFS/IDHFS) shoulders new responsibilities for implementing panels, outreach, pilot programs, reporting, and coordination with other state agencies.
  • Safety Net and Community Organizations: Not-for-profit organizations and safety-net facilities may participate in navigation, outreach, and the equipment grant programs, subject to federal approval.
  • Imaging Centers: State-qualified ACR Designated Comprehensive Breast Imaging Centers; subject to quality standards and potential collaborations with hospital facilities.

4) Procedural and Timeline Aspects

  • Expert panels to be convened no later than January 1, 2027; panels to meet quarterly thereafter.
  • Initial baseline and ongoing quality standard development, with a later framework linking rates to the panels’ quality standards and designated imaging centers.
  • Pilot for patient navigation to be evaluated; permanent Patient Assistance for Beneficiaries Diagnosed with Breast Cancer to be established within 2 years after pilot completion, with annual reporting beginning in the first fiscal year after permanent establishment.
  • By April 1, 2027, Department to report progress on the rate methodology and implementation efforts to the General Assembly.
  • The bill contemplates federal waivers/approvals for several provisions, including the rate methodologies and certain program expansions (e.g., PACE, newborn screening, etc.).

Notes

  • The bill is comprehensive and touches many areas beyond mammography, reflecting a broad modernization of Medicaid services and supports. The core breast cancer provisions are designed to improve screening access, standardize quality, reduce financial barriers, and ensure navigational support for affected beneficiaries.

Compiled from official sources — confirm details with the bill’s official record.

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