Transcript Slide 1

900 Lydia Street - Austin, Texas 78702
Phone (512) 320-0222 – fax (512) 320-0227 www.cppp.org
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 ([email protected])
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Background: Medicaid BCCPTA
• New Medicaid eligibility option enacted in 2000
• Linked to CDC public health program (NBCCEDP)
• Medicaid coverage for:
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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
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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.
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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
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Target population = uninsured women under 65
Treatment oriented
Not income limited
Entitlement
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“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.
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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)
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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.
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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).
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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.
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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.
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CMS Q&A on Medicaid BCCPTA
http://new.cms.hhs.gov/MedicaidEligibility/
downloads/breastandcervical4.pdf
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