Illinois Mandates Medicaid Reimbursement for Sera Prognostics PreTRM Test Covering 50,000 Births
SERA•Illinois's amended Public Aid Code mandates Medicaid coverage and reimbursement for Sera Prognostics’ PreTRM® proteomic blood test and related care management services, covering roughly 50,000 Medicaid births annually. The test’s clinical validation identifies spontaneous preterm birth risk, potentially reducing complications among the 13,042 preterm births recorded in Illinois in 2024.
1. Illinois Expands Medicaid Coverage
Illinois’s Public Aid Code has been amended to require Medicaid to cover and reimburse proteomic blood tests prescribed to assess spontaneous preterm birth risk, including associated care management services and interventions shown to improve maternal and neonatal outcomes.
2. Scale of Affected Births
Approximately 50,000 Medicaid-funded births occur annually in Illinois, where 250 babies are born preterm each week, totaling 13,042 preterm births in 2024 and highlighting significant opportunities to reduce clinical and financial burdens on state healthcare programs.
3. PreTRM Test Validation
Sera Prognostics’ PreTRM® Test, the only broadly validated blood-based test of its kind, measures protein biomarkers in weeks 18 through 20 of pregnancy to identify at-risk individuals and enable personalized interventions that improve outcomes.
4. Implementation and Future Outlook
While specific implementation timelines and coverage parameters are still being defined, Sera is collaborating with policymakers and healthcare stakeholders in Illinois to support rollout, with potential to inform similar reimbursement frameworks in other states.
