If you’re pregnant, California will begin paying for a new health screening
California will offer DNA screening to pregnant people who want to evaluate the risk of chromosomal abnormalities in their fetuses starting in mid-September.
Cell-free DNA screening measures the risk that a fetus has certain chromosomal conditions by analyzing fetal cells in a pregnant person’s blood. It’s supposed to be offered to all pregnant patients, according to standards set by the American College of Obstetricians and Gynecologists (ACOG). With new changes to the California Department of Public Health’s Prenatal Screening Program, the test will be available for the first time to many lower-income Californians.
Without insurance, the fee is $221.60, but the screening will be covered by Medi-Cal and many private insurers. Particularly for Medi-Cal beneficiaries, said midwife Madeleine Wisner, this increased access “is huge.”
“It is the standard of care now,” said Wisner, who runs Welcome Home Midwifery Services in Sacramento. “We offer it to everyone, but it has been cost-prohibitive for a lot of folks.”
For years, California’s Prenatal Screening Program has offered an older type of screening that leads to more false positives. Because the state pays for follow-up care and tests, the cfDNA screening is expected to save money and reduce anxiety by eliminating many false positives.
The state plans to begin testing people who are 10 or more weeks along in their pregnancies starting Sept. 19.
ACOG calls cfDNA screening “the most sensitive and specific screening test” for common fetal conditions in which an extra chromosome is present or a full chromosome is missing (there are 46 chromosomes in a typical human cell). The test uses fetal DNA present in the parent’s bloodstream; follow-up testing can confirm a diagnosis. Although cfDNA can expose heightened risk for a range of chromosomal issues, California’s screening program will identify risks only for trisomy 21, more commonly called Down syndrome, and trisomies 18 and 13. Trisomies 18 and 13 often lead to miscarriage; when babies are born with either condition, they usually die before their first birthday.
An ACOG practice bulletin issued in 2018 said that cfDNA screening is one of the prenatal health care options that “should be discussed and offered to all pregnant patients regardless of age or risk for chromosomal abnormality.”
Prenatal screenings not on offer
This expansion of testing brings the state closer to delivering adequate prenatal care to all Californians, but some practitioners criticized the program for not offering sex chromosome aneuploidy screening. “Sex chromosome aneuploidies are the most common chromosomal abnormality,” said Jitsen Chang, a Los Angeles OB-GYN. “In fact, sex chromosome aneuploidies are more common than trisomy 21, 18 and 13 combined.”
Because both wealthier and more connected people could seek out additional screening outside the state program, Felicia Jones, CEO of the nonprofit Healthy African American Families II, agreed with Chang in a column in the Los Angeles Sentinel. Last year, Jones wrote, “White or Asian patients will be more likely to have the means and opportunity to access screening for the additional conditions not offered in the state program. Meanwhile, those in predominantly Black or Hispanic under-served communities will be relegated to the more basic screening offered by CDPH and will have more babies born with these conditions without access to the critical information.”
A bill working its way through the legislature appears to partially address the gaps in the state program. Senate Bill 771, sponsored by Senator Josh Becker and Assemblymember Akilah Weber, would ensure that participants in the state program could still get additional screenings at public labs; it would also help ensure that people who opt out of the Prenatal Screening Program can still get the tests elsewhere.
Regardless, the expanded care is an improvement for Medi-Cal beneficiaries, Wisner said; previously, cfDNA screens were covered only under certain circumstances.
“It’s a big deal that it’s going to be covered for everyone, even low-risk folks.”
