GAO: Breast cancer screening location affects eligibility for treatment coverage
In 1990, Congress authorized the Centers for Disease Control and Prevention (CDC) to fund screening and diagnostic services to low-income, uninsured and underinsured women, which led to the creation of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Ten years later, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act, allowing states to extend Medicaid eligibility to these same women if they were diagnosed with breast or cervical cancer.
From May 2008 to May 2009, the GAO examined the NBCCEDP's screening of eligible women from 2002 to 2006, states' implementation of the Treatment Act, Medicaid enrollment and spending under the Treatment Act, and alternatives available to women ineligible for Medicaid under the Treatment Act.
Under the screening program, about 1.1 million women were screened for breast cancer, and 18,937 breast cancers were detected. Similarly, about 1.1 million women were screened for cervical cancer, and 22,377 cervical cancers and precursor lesions were detected.
The study highlighted two findings:
1) Due to a lack of funding, more than half of eligible low-income, uninsured and underinsured women are not receiving recommended breast cancer screening; and
2) More than a dozen states have left in place restrictions to Medicaid coverage for breast and cervical cancer screening that effectively eliminate all but a small fraction of low-income women, leaving the rest with few, if any, options for assistance.
"Whether you live shouldn't depend on where you live," said Ambassador Nancy G. Brinker, chair of the Susan G. Komen for the Cure Advocacy Alliance. "Regretfully, this report confirms what we've long seen - that your ability to be treated for breast cancer often depends on what state you live in, whether you live in a city or rural area, and even if you went to the ‘right' clinic."
The Komen Advocacy Alliance, which has advocated at both the federal and state level to close the gaps in access, worked with Senators Max Baucus, Barbara Mikulski and Debbie Stabenow to request the study.
According to the GAO report:
- 16 states, plus the District of Columbia, currently limit access to Medicaid coverage for treatment only to those women who were screened and diagnosed at a clinic that has received CDC funds under the NBCCEDP program.
- Due to limited funding, state NBCCEDP providers only screen 15 percent of eligible women on average nationally.
- About 26 percent are screened by other providers, such as free clinics and mobile vans, some of which are funded by Susan G. Komen for the Cure Affiliates. Unfortunately, these resources are limited and often not available in rural or other underserved areas.
- About 60 percent of eligible women do not receive recommended breast cancer screening from any provider - a disturbing revelation that is much higher than previously understood. Screening is important as 98 percent of women survive at least five years if their breast cancer is discovered early, before it spreads beyond the breast.
- The increased restriction significantly limits the number of women who are able to enroll in Medicaid for their treatment. For example, South Carolina increased its enrollment of women who entered Medicaid through the Treatment Act from 162 women to 614 during the two years after they eased their restrictions in 2004.
- Few statewide options for treatment are available to low-income, uninsured women who are diagnosed with breast or cervical cancer but ineligible for Medicaid under the Treatment Act. Komen Affiliates help to fill this gap in many communities.
Download the entire report at http://www.gao.gov/products/GAO-09-384.