PROMPT: Policy Research on Medicaid Program Coverage of Rapid Genomic Testing

Rapid genome sequencing (rGS) can provide timely molecular diagnoses for critically ill infants with suspected genetic conditions, informing clinical management and improving health outcomes while potentially reducing healthcare costs. Although evidence supports the clinical and economic value of rGS, access remains inconsistent due to variation in insurance coverage and reimbursement policies. In recent years, state Medicaid programs have begun covering rGS for critically ill infants.

This study will evaluate the implementation and impact of Medicaid coverage of rGS on health and economic outcomes among critically ill infants. We will characterize coverage policy design and implementation through policy analysis and interviews with policymakers, hospital leaders, and clinicians. We will also assess the effect of payer coverage on rGS utilization and outcomes. Finally, we will model the projected health and economic outcomes of alternative coverage approaches from the public payer perspective. Findings from this research will be useful to inform policy and practice across states and hospitals, supporting efficient delivery of high-value genomic medicine to improve child health outcomes.