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25-804m Help Prevent Tuberculosis. Make Screening Part of Routine Care

Date: 08/08/25

Identify, test and treat at-risk adults during regular visits to stop TB before it starts

The California Department of Public Health (CDPH) Tuberculosis Control Branch has issued updated guidance on tuberculosis (TB) screening. This update was developed in collaboration with the Department of Health Care Services
Medi-Cal Program as part of preventive care efforts.

Despite being preventable, TB continues to cause significant illness and death in California. Notably, 68% of TB cases occur among Medi-Cal enrollees. TB has a greater impact on Asian, Black, Latin and Native American communities, reflecting a significant health disparity. More than 80% of TB cases in California are preventable through testing and treatment of asymptomatic TB infection (also known as latent TB infection or LTBI).

Primary care providers play a vital role in identifying and managing patients at risk.

The Bacille Calmette-Guérin (BCG) vaccine does not provide lifelong protection against TB. Therefore, the most effective strategy to prevent TB is to diagnose and treat LTBI.

CDPH recommends the following steps:

  1. Screen all patients for TB risk factors using the California TB risk assessment.
  2. Test those with risk factors, preferably using an interferon gamma release assay (IGRA).1,2
  3. Rule out active TB with a symptom screen and chest X-ray before starting LTBI treatment.
  4. Treat LTBI with 3-4 month rifamycin-based therapies:
  • 4 months of rifampin, or
  • 12 weeks of isoniazid plus rifapentine (preferred for most patients).

These recommendations align with guidance from the U.S. Preventive Services Task Force, the Centers for Disease Control and Prevention (CDC), the Infectious Diseases Society of America, and the American Academy of Pediatrics.

TB assessment criteria for Medi-Cal patients

1. Who should be assessed. 

All adult Medi-Cal patients receiving primary care must be offered a TB risk assessment. If risk factors are found, a TB screening test should also be offered—unless one of the following applies:

  • The patient is in a life-threatening emergency.
  • The patient has already been assessed or tested and has no new risk factors.
  • The patient has a documented positive TB test (e.g., IGRA or LTBI).
  • The patient cannot give consent and no legal representative is available.
  • The patient is being treated in a hospital emergency department.

2. If the test is positive. 

If the patient accepts the test and it is positive, the provider must either:

  • Offer follow-up care, or
  • Refer the patient to a provider who can.

Learn more on how to prevent the spread of TB, please refer to provider update 24-1279m, Prevent the Spread of Tuberculosis During Regular Check-Ups.

New requirement under AB 2132

Assembly Bill 2132 took effect on January 1, 2025. It requires primary care providers in California to offer TB screening to adult patients with identified risk factors. This applies if the screening is covered by the patient’s health insurance. If a patient tests positive, the provider must offer follow-up care or refer the patient for treatment of latent TB LTBI. The goal of this law is to improve early detection and reduce the spread of TB in high-risk populations.

Patients not eligible for full-scope Medi-Cal may still qualify for no-cost outpatient TB services under aid code 7H through the Medi-Cal Tuberculosis Program (PDF).

Available webinars

The CDPH TB Control Branch offers twice-yearly webinars on LTBI best practices for primary care clinicians. For upcoming training details, email.

For questions about TB clinical care or for additional resources, please send an email to the CDPH TB Control Branch.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.

1Commercially available interferon gamma release assays (IGRA) include T-SPOT.TB (Oxford Immunotec Global), and QuantiFERON-Gold Plus (Qiagen).
2Patients who have received BCG vaccine should be tested using IGRA; they are not protected from developing TB disease later in life.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.



Last Updated: 08/07/2025