by
Gus Iversen, Editor in Chief | July 29, 2025
A study from the Harvey L. Neiman Health Policy Institute links Missouri’s 2019 expansion of mammography coverage to increased screening rates and a rise in the use of digital breast tomosynthesis (DBT), especially among Medicaid-insured women.
The law mandated annual screening mammograms starting at age 40 (previously biennial beginning at age 50), and required insurance coverage for DBT, also known as 3D mammography, in addition to standard full-field digital mammography (FFDM).
Researchers analyzed data from over 1 million women and found that following the policy change, Missouri women with Medicaid were 45% more likely to undergo screening mammography compared to those insured through Medicare Advantage, which is federally regulated. They also found a 9% increase in screening rates when comparing Missouri Medicaid recipients to similar women in bordering states not subject to the law.
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“Among women in Missouri, we found that those with Medicaid insurance were 45% more likely to have screening mammography after the law change compared with women insured through Medicare Advantage,” said Eric Christensen, Ph.D., research director at the Neiman Institute and senior author of the study.
Commercially insured women in Missouri showed a smaller increase — about 5% compared to the Medicare Advantage group — but no significant difference compared to peers in neighboring states. “The lesser impact of the law for increasing screening among commercially insured women was expected. Laws dictate minimum coverage only, and commercial insurers often offer coverage that exceeds these requirements,” Christensen noted.
The law was also associated with a greater shift toward DBT. Use of DBT increased by 64% among Missouri Medicaid patients and by 24% among commercially insured women, compared to similar populations in bordering states. Prior Neiman Institute research has cited delayed access to DBT among women with dense breast tissue as a contributor to disparities in detection.
“This study shows that policy change matters, and can improve access to lifesaving screening,” said lead author Amy K. Patel, M.D., medical director of The Breast Care Center at Liberty Hospital.
The study was published in the
Journal of the American College of Radiology.
