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Slipping Through the Cracks of the Breast and Cervical Cancer Prevention and Treatment Act of 2000—A Tragic Case of Failed Access to Care

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Abstract:

Two federal laws, the Breast and Cervical Cancer Mortality Prevention Act of 1990 and the Breast and Cervical Cancer Prevention and Treatment Act, were passed with the intent of increasing financial access to breast cancer screening and treatment for eligible uninsured women in the United States. The Treatment Act provides states with the opportunity to expand Medicaid coverage to women in need of treatment for breast and cervical cancer as a Medicaid optional eligibility category. Women may be eligible for Medicaid coverage under this category if (a) screened through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and are found to have breast or cervical cancer, (b) under 65 years of age, and (c) uninsured and not eligible for Medicaid under other eligibility categories. Individual states have flexibility in how “screened through the program” is defined. However, 17 states, including Minnesota, chose to only provide Medicaid coverage within this program for women who were screened or diagnosed with Centers for Disease Control and Prevention (CDC) funds—the most restrictive eligibility category. This case study describes the experience of one uninsured woman with breast cancer who lived in Minnesota. She received a screening mammogram from a provider who did not participate in Minnesota's cancer Early Detection Program and was therefore ineligible for Medicaid coverage to receive medically necessary treatment for her cancer. After describing the case, the benefits and limitations of the breast cancer legislation are summarized. The Patient Protection and Affordable Care Act (PPACA) of 2010 is then briefly analyzed with respect to the potential for this act to eliminate the financial access-related limitations of the breast cancer legislation. Recommendations for policy changes at the federal and/or state level are made with respect to the eligibility provisions of the Breast and Cervical Cancer Prevention and Treatment Act. The proposed policy changes are expected to reduce the occurrence of women slipping through the cracks of breast cancer screening and treatment legislation.

Keywords: BREAST CANCER; HEALTH CARE REFORM; POLICY; UNINSURED

Document Type: Research Article

DOI: http://dx.doi.org/10.1891/1073-7472.14.3.4.96

Publication date: December 1, 2011

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