Medicaid coverage of BRCA screening and counseling is a hodgepodge of state policies. A 2012 report from the Kaiser Family Foundation concluded that BRCA is not typically covered [PDF]. It identifies 24 states, including Indiana and New York that cover both screening and counseling; 18 states cover one service or the other; 14 states charge copays for one or both of these services. Six states, including Florida, Alabama, and Louisiana, cover neither service.
Grace Wang, PhD, senior researcher with the American Institutes for Research and an author of the NCBI study, says Medicare tends to be conservative around policies on preventive service and perhaps with good reason. "National coverage decisions receive a lot of scrutiny and criticism. There isn't much flexibility to change once a decision is made."
Still, Medicare's lack of consistent and explicit guidelines for BRCA means a patient's geographic location may play more of a role in approval for testing than the need for that testing. "The requirements can be very narrow is some areas," notes Wang.
Through her work in film, as a Goodwill Ambassador for the UN High Commissioner for Refugees, and as an adoptive parent, Angelina Jolie has lived and worked all over the globe. She's even written a book called Notes from My Travels: Visits with Refugees in Africa, Cambodia, Pakistan and Ecuador.
If she were dependent on Medicare to pay for her healthcare, Jolie would likely not have been in a position to write these words in the New York Times: "I feel empowered that I made a strong choice… Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of."