1

Texas Medicaid and the Breast And Cervical Cancer Prevention

and Treatment Act Texas Health Care Access Conference

Texas Association of Community Health Centers/Covering Kids and Families/Texas CHIP Coalition

February 28, 2006

Anne Dunkelberg, Assistant Director (dunkelberg@cppp.org)

900 Lydia Street - Austin, Texas 78702Phone (512) 320-0222 – fax (512) 320-0227 - www.cppp.org

2

Background: Medicaid BCCPTA• New Medicaid eligibility option enacted in 2000• Linked to CDC public health program (NBCCEDP)• Medicaid coverage for:

– Women, – “Screened under the program” (state options here)– “In need of treatment”– Under age 65– Uninsured/underinsured

• Full Medicaid coverage until cancer treatment ends• Enhanced federal match • Medicaid income eligibility limits do not apply;

immigration eligibility restrictions do apply• States have IMPORTANT OPTIONS which affect the

number of women who get help-- variation is substantial

3

The Awful Acronyms

• Federal law that created the Medicaid coverage option is the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA); this is how federal Medicaid authorities (CMS) refer to the Medicaid coverage.

• Just for today’s presentation, I will refer to “BCC Medicaid.”

• Eligibility for BCC Medicaid is LINKED to the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP); this is how FEDS refer to this cancer screening program.

• In TEXAS, the NBCCEDP screening program is administered by the Texas Department of State Health Services (DSHS), and THEY refer to their screening program as Breast and Cervical Cancer Control Services (BCCCS). So you may see “NBCCEDP” and “BCCCS” used interchangeably in Texas.

4

BCC Medicaid Links 2 Programs that are Quite Different

• NBCCEDP: public health, surveillance, outreach• Target population = non-screened women, regardless of

insurance status; age 40-64 (breast), 18-64 (cervical) • 15% of eligible population screened• Provides clinical breast examinations, mammograms, pelvic

examinations, and Pap tests through 42 Texas contractors • Income eligibility limit of 200-250% FPL; no cost to client• Block grant funding limited

• BCC Medicaid: coverage• Target population = uninsured women under 65• Treatment oriented• Not income limited• Entitlement

5

“Screened Under the Program”? • The federal law says a woman must be “screened under the

NBCCEDP” program to be eligible for the BCCPTA Medicaid coverage.

• BUT: states actually have LOTS of flexibility to DEFINE “screened under the program.”

• There are 3 options for defining “screened under the program.”

• The impact of the different choices can be quite significant: – Texas chose #1, and Georgia #3, – as a result Texas served 1,200 women over roughly the same period

that Georgia served 4,200 – Even though our population at 22.3 million is over 2.5 times theirs at 8.7

million.

6

Screened Under the Program Defined

• Three options

1. NBCCEDP (Title XV) funds paid for all or part of screening service (26 states, e.g. CO, IN. MT, PA, TX)

2. The individual’s screening may not have been paid directly by NBCCEDP, but the provider is one who receives Title XV funds (13 states, e.g. IL, MD, NY)

3. Screening rendered by any other provider/entity designated by the state (11 states, e.g. CA, GA, TN)

7

Option 1 is Narrowest: Consequences

• Excludes women screened elsewhere: • Uninsured women in “Option 1” states (including Texas)

who: • pay out of pocket or • get charity care for screening, or • Get diagnosed in the ER

• Become ineligible for BCC Medicaid if the provider listed above was not one of the 42 NBCCEDP contractors.

• American Cancer Society toll-free helplines have identified numerous Texas women in this situation.

8

Option 3

Georgia uses Option 3 • recognizes any licensed provider

• Patients screened/diagnosed by any appropriately licensed provider are referred to an NBCCEDP contractor.

• Those meeting 200% FPL income eligibility standard are referred to Medicaid for BCC Medicaid.

• as a result, Georgia served 4,200 women over roughly the same period that Texas served just 1,200.

• Even though our population at 22.3 million is over 2.5 times theirs (at 8.7 million).

9

Next Steps for Advocates, Providers: Increase Public

Awareness!• The Women’s health waiver will provide many more women access

to screening.

• So, it will be more important than ever for ALL providers, advocates, and CBOs to understand how the current “option 1” pathway to BCC Medicaid works in Texas TO ENSURE THAT NOT A SINGLE ELIGIBLE UNINSURED WOMAN IS DENIED COVERAGE!

• This may require all of us partnering with the state to help educate all health care providers on the correct way to make sure a woman gets BCC Medicaid coverage.

10

Next Steps for Advocates, Providers: Opportunity for Change

• Texas law (Senator Jane Nelson’s SB 532, which became law in 2001) does NOT require Texas to use Option 1.

• Recent awareness of the problems with Option 1 could result in the policy being changed to Option 3 without any action by the Legislature.

• If not changed at the agency level, watch for possible legislative action in January 2007.

11

CMS Q&A on Medicaid BCCPTA

http://new.cms.hhs.gov/MedicaidEligibility/

downloads/breastandcervical4.pdf