CA will offer a new DNA test for pregnant women who use Med-Cal
California will offer DNA screening to pregnant women who want to assess the risk of chromosomal abnormalities in their fetus starting in mid-September.
Cell-free DNA testing measures the risk of a fetus having certain chromosomal conditions by analyzing fetal cells in a pregnant person’s blood. It is 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 many low-income Californians for the first time.
Without insurance, the fee is $221.60, but screening will be covered by Medi-Cal and many private insurers. Especially for Medi-Cal recipients, said midwife Madeleine Wisner, this increased access “is huge.”
“It’s the standard of care now,” said Wisner, who runs Welcome Home Midwifery Services in Sacramento. “We offer it to everyone, but it’s been prohibitively expensive for a lot of people.”
For years, California’s prenatal screening program offered an older type of screening that leads to more false positives. Because the state pays for follow-up care and testing, cfDNA screening should save money and reduce anxiety by eliminating many false positives.
The state plans to begin testing people who are 10 weeks or more pregnant 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 complete 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 tests can confirm a diagnosis. Although cfDNA may expose an increased risk for a range of chromosomal issues, the California screening program will identify risks only for trisomy 21, more commonly known as Down syndrome, and trisomies 18 and 13. Trisomies 18 and 13 often result in miscarriage; when babies are born with either condition, they usually die before their first birthday.
An ACOG practice bulletin published in 2018 stated that cfDNA screening is one of the prenatal healthcare options that “should be discussed and offered to all pregnant patients, regardless of age or risk of chromosomal abnormality”.
Prenatal screening not offered
This testing expansion brings the state closer to providing adequate prenatal care to all Californians, but some practitioners have criticized the program for not offering sex chromosome aneuploidy testing. “Sex chromosome aneuploidies are the most common chromosomal abnormality,” said Jitsen Chang, OB-GYN in Los Angeles. “In fact, sex chromosome aneuploidies are more common than trisomies 21, 18, and 13 combined.”
Because the wealthiest and most connected people might seek additional screening outside of the state program, Felicia Jones, CEO of the nonprofit Healthy African American Families II, agreed with Chang in a column from the Los Angeles Sentinel. Last year, Jones wrote: “White or Asian patients will be more likely to have the means and the opportunity to access testing for additional terms not offered in the state program. Meanwhile, those in underserved predominantly Black or Hispanic communities will be relegated to the more basic screening offered by CDPH and will have more babies born with these conditions without access to critical information.
A bill making its way through the legislature appears to partially fill the gaps in the state’s agenda. Senate Bill 771, sponsored by Sen. Josh Becker and Assemblywoman Akilah Weber, would ensure that participants in the state program could still benefit from additional testing at public labs; it would also help ensure that people who opt out of the prenatal screening program can still take the tests elsewhere.
Either way, expanded care is an improvement for Medi-Cal recipients, Wisner said; previously, cfDNA screens were only covered under certain circumstances.
“It’s a big deal that it’s covered for everyone, even low-risk people.”