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Why Does Arizona’s Medicaid Program Limit Access to NIPT?

Our mission at Stand Up for APA is simple: we work to ensure that all pregnant women throughout the U.S. have equitable access to the best prenatal and maternal care options, which includes newer, safer, and more accurate technologies like non-invasive prenatal tests (NIPT or NIPS).

Screening tests – which allow expecting mothers to identify genetic disorders in their babies – are a critical component to the prenatal care needed to guarantee a mother’s healthy pregnancy. Leading medical societies such as the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal Fetal Medicine (SMFM), and the American College of Medical Genetics (ACMG) have updated their prenatal screening guidelines to recommend the safest, most accurate prenatal genetic screening tests – NIPT – to all pregnant women. Unlike traditional options like serum or combined screening, NIPT uses a mother’s blood sample to analyze a baby’s DNA for common genetic abnormalities. As a result, it can predict chromosomal disorders with much greater precision than traditional screening methods.

Arizona’s state Medicaid program relies on Hayes Technology Assessment for policy guidance on these critical services. Hayes Inc. – a private corporation that “serves payers and providers with superior evidence, analysis, and responsive, customized research tailored to meet a client’s specific needs” – however, has yet to include ACOG’s most recent guideline recommendations for NIPT coverage.

Hayes Inc., which claims to be “committed to advancing healthcare through fiercely unbiased research, scientifically rigorous reporting, and expert assessments of the clinical evidence behind new and emerging health technologies,” have thus far ignored ACOG, SMFM, and ACMG’s recommendations to provide NIPT access to all pregnant women. And by failing to update their guidelines around NIPT, Hayes is failing Arizona’s pregnant mothers who receive Medicaid benefits.

Unlike most private insurers that provide NIPT coverage to all Arizonan women regardless of risk factor, Arizona’s Medicaid program (known as the “Arizona Health Care Cost Containment System” or AHCCCS) still restricts NIPT access to mothers deemed “high-risk.” These are women who are over the age of 35 or who have had a prior pregnancy with a genetic abnormality. Furthermore, 18 state Medicaid programs have already updated their policies to cover NIPT for all pregnant women – with many other states expected to follow.

By failing to update their guidelines around NIPT, Hayes is preventing pregnant mothers – particularly those who receive Medicaid benefits – from receiving the safest, most accurate prenatal testing.

What can I do to hold Hayes & AHCCCS accountable?

First, we must continue to educate all Arizona mothers on the critical need to provide NIPT access for all. Second, we must raise our voices and let not only our state’s public officials and providers know – but also Hayes leadership – that we will not stay silent until all Arizona mothers have access to the best maternal and prenatal care available.

Please feel free to print out and share our fact sheet below, and let both AHCCCS and Hayes know that every mother needs access to NIPT – no matter what.

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