New York budget proposal threatens to roll back biomarker testing coverage, health care advocates say

Three years ago, New York state took a huge step forward by expanding access to biomarker testing, which is said to be a game changer in cancer care.

Now, however, advocates fear the state could be taking a step back for those with Medicaid.

Biomarker testing changes

In 2023, Gov. Kathy Hochul signed a bill into law requiring insurance providers, including Medicaid, to cover biomarker testing.

But health care advocates said her current budget proposal threatens to reverse that progress by requiring Medicaid enrollees to meet "medical necessity criteria" for coverage.

The 2027 executive budget briefing book states, "In 2023, the Governor signed legislation to cover biomarker precision testing as a Medicaid benefit. Biomarker precision testing allows doctors to identify measurable indicators that signal normal or abnormal biological processes and treatment responses. The Budget clarifies that all biomarker precision tests covered by Medicaid meet required medical necessity criteria."

A spokesperson for the governor released the following statement:

"The Governor has significantly expanded access to cancer care by advancing initiatives that make care more affordable, particularly early detection and screenings. This proposal does not roll back coverage but instead aims to further ensure patient safety in accordance with evidence-based and peer-reviewed guidelines. Nothing in this proposal changes the fact that biomarker precision medical testing is a covered benefit for Medicaid enrollees and the Governor will continue to negotiate in good faith with the Legislature to pass a state budget that protects healthcare access for New Yorkers."

Assembly Member Pamela Hunter, who championed the 2023 bill, said in a statement:

"I am proud to have worked with Senator Persaud and Governor Hochul to increase access to groundbreaking biomarker tests that have had so much positive impact on the lives of patients. The law, enacted in 2024, covered biomarker tests for both commercial plans and Medicaid, making it available no matter what a person's income was as long as the test was deemed medically necessary under agreed upon criteria. This is precision diagnostic testing that makes treatments more targeted and often more successful. In the current state budget negotiations, there are proposals to remove criteria for Medicaid patients. As these negotiations continue, I am working to preserve what is in enacted law and maintain access to these lifesaving tests."    

The importance of biomarker testing access

Cancer survivors and advocates gathered outside the governor's Manhattan office Tuesday. Among them was Lexy Mealing, who was diagnosed with breast cancer at age 52.

"It was life-shattering," she said.

Nearly five years later, she's in remission and believes biomarker testing was integral to her survival.

"[The biomarker testing] helped my physicians have a clear, open path to the treatment plan that was best for me," she said.

Mealing said she and others want "to urge state lawmakers to reject [Hochul's] proposal to roll back Medicaid coverage of biomarker testing."

Advocates say this doesn't just impact cancer patients but those with a wide range of diseases.

"There are diseases out there where there is no cure right now, like ALS. But one day, there will be a cure, and it will come because of biomarker testing," said Michael Davoli, with the American Cancer Society Cancer Action Network.

"I've watched for too long as people of color, low-income individuals, and neighbors of mine disproportionately shoulder the burden of disease like cancer," Bronx resident and lung cancer survivor Jacqueline Nesbit said. "It's largely because we've been shut out of advances like biomarker testing."

"We should not be balancing the state budget on the backs of cancer patients," Davoli said.