Require insurance, Medicaid cover colorectal cancer screenings

136th Legislature (2025-2026) Introduced by Desireè Tims

Requires private insurance and Medicaid to cover colorectal cancer screening for adults 21+ with cost-sharing no higher than for 45+, aligning with ACA parity.

Referred to committee

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Summary of HB 922 (Ohio, 136th General Assembly)

Purpose and intent

HB 922 seeks to require insurance and Medicaid coverage for colorectal cancer screening tests for adults aged 21 and older. The bill aims to align Ohio’s coverage for these screenings with the federal standards established under the Patient Protection and Affordable Care Act (ACA), specifically mirroring the coverage rules that apply to individuals aged 45 and older.

Key provisions

Section 3902.65 – Health benefit plans (private insurance)

Health benefit plans must cover colorectal cancer screening tests for individuals aged 21 and older.
Coverage is required to be on the same basis as coverage for individuals aged 45 and older under ACA section 2713.
The law prohibits cost-sharing for the 21+ group to be greater than the cost-sharing already applicable to the 45+ group for colorectal cancer screening tests.

Section 5164.081 – Medicaid

Ohio’s Medicaid program must cover colorectal cancer screening tests for individuals aged 21 and older.
Coverage for 21+ must be on the same basis as coverage for 45+ under ACA section 2713.

Section 2 – Effective applicability

The new requirements apply to health benefit plans delivered, issued for delivery, modified, or renewed on or after the effective date of the new section (i.e., post-enactment timeframe).

Affected parties

Individuals 21 and older: Eligible for colorectal cancer screening coverage under both private health plans and Medicaid without increased cost-sharing relative to the ACA benchmarks for 45+.

Insurance issuers and health benefit plans: Required to adjust coverage terms to meet the 21+ parity with 45+ ACA standards.

Medicaid program: Must implement parity in coverage for screenings for the 21+ population.

Procedural and timeline aspects

The new requirements are tied to plans issued, delivered, modified, or renewed on or after the section’s effective date.

The bill references ACA section 2713 for alignment, leveraging existing federal standards for preventive screenings.

Co-sponsor: Desireè Tims (adds legislative support and sponsorship context).

Potential impact

Increases access to colorectal cancer screening for adults starting at age 21.

Reduces potential out-of-pocket costs for screenings by aligning private insurance and Medicaid with ACA parity rules.

Supports early detection and prevention efforts for colorectal cancer among a broader adult population.

May necessitate administrative updates by insurers and Medicaid to ensure plan documents and cost-sharing structures comply with the new parity requirements.