Assist the Uninsured Diagnosed with Cancer

Help Parents and Protect more Children with SCHIP Expansions and Improvements

Monitor Medicaid under the Deficit Reduction Act of 2005

ASSIST THE UNINSURED DIAGNOSED WITH CANCER

In February 2000, the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) was enacted (Public Law 106-354) to provide medical assistance through Medicaid to eligible women who were screened through the Center for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program and need treatment for breast or cervical cancer. Under this plan, patients are able to receive critical services, including radiation treatment, chemotherapy, and basic laboratory services; remaining eligible for the program for the duration of their cancer treatment.

Where the Issue Stands:

All fifty states and the District of Columbia chose to implement this option in their Medicaid plan and this investment of $220 million over 5 years helped to bring down financial barriers to treatment. States may also choose the presumptive eligibility option to facilitate and expedite the eligibility process. Presumptive eligibility is an additional Medicaid option that allows states to enroll women in Medicaid for a limited period of time before full Medicaid applications are filed and processed, based on a determination by a Medicaid provider of likely Medicaid eligibility. Delays in needed treatment for diagnosed women can worsen disease, and this option helps to provide the treatment without delay.

While all fifty states and the District of Columbia have chosen to implement the Medicaid program option enabled by the BCCPTA, only 22 states have chosen the presumptive eligibility option as of January 2007.

In an alternative approach to assisting the uninsured diagnosed with cancer, Delaware's independent, one-of-a-kind Cancer Treatment Program covers the uninsured diagnosed with cancer and income less than 650% of the federal poverty level. Delaware's program is not a part of the State's Medicaid program.

Many of the uninsured Americans that contact our companion organization, Patient Advocate Foundation, have a diagnosis of other types of cancer and live below the federal poverty level. These individuals may not have any dependent children in the home, or may not meet the other qualifying criteria for admission to the Medicaid program. Consequently, they may experience delay in care or seek treatment in the emergency rooms and county hospital systems. While fiscal constraints and budgetary issues at the state level are challenging, states already absorb the costs of the care delivered to this population through increased costs to public health clinics and community hospitals and to the accrual of additional costs due to the severity of the patient's condition.

Action needed:

The National Patient Advocate Foundation advocates proposing legislation that assists the uninsured who face a diagnosis of cancer. We encourage all states to choose the optional coverage for presumptively eligible women and, as passed in South Carolina 2005, cover uninsured women diagnosed with breast and cervical cancer even if they were not screened through the CDC screening programs.

We also advocate for more comprehensive legislation that would encompass all forms of cancer as an immediate qualifier for Medicaid. One example of such legislation is a bill introduced in Missouri by State Senator Pat Dougherty. Senator Dougherty's bill (Missouri Senate Bill No. 634), would have added a diagnosis of cancer as a qualifying category to Medicaid (subject to the program income and access eligibility requirements). The Deficit Reduction Act of 2005 gives states new options for covering citizens and implementing ways in which late-stage illness may be prevented by early treatment. NPAF asks that the State Medicaid programs add the diagnosis of cancer as a qualifying event allowing access to medical care, for example, under a specified "Catastrophic Illness" or other appropriate provision.

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HELP PARENTS AND PROTECT MORE CHILDREN WITH SCHIP EXPANSIONS AND IMPROVEMENTS

The State Children's Health Insurance Program (SCHIP) was created by United States Congress as part of the Balanced Budget Act of 1997. Through SCHIP, the federal government gives each state a pool of money to be used to provide uninsured children with health insurance. SCHIP is intended to supplement the Medicaid program by providing coverage for low-income children whose incomes are too high to qualify for Medicaid but whose families cannot afford private health insurance. In 2005, Medicaid covered 28 million children in the US, making it the largest provider of health insurance for children, and SCHIP covered an additional six million. Combined, these two programs provide coverage for 25% of all children in the US. SCHIPs are administered by the Centers for Medicare and Medicaid Services (CMS) and are also known as the Healthy Kids program in Florida as well as KidCare in several other states.

Where the Issue Stands:

The number of uninsured persons in the U.S. is increasing: more than 46 million Americans lacked health insurance in 2005, including 9 million children. California, Texas, Florida, New York, Illinois have the highest rates of uninsured children; these states combined represent almost half of the uninsured child population in the US. Uninsured children are more likely to suffer from preventable illnesses, are subject to more unnecessary hospitalizations, and have worse outcomes than their insured counterparts.

Many uninsured parents who contact the Patient Advocate Foundation report participation of their children in a state-run SCHIP but are unable to secure coverage for themselves; because healthy, covered parents are better able to promote the health of their children, NPAF proposes legislative and regulatory actions that assist both children and their parents.

Action needed:

NPAF advocates expansion of the State Children's Health Insurance Programs to cover more uninsured children, including immediate "fallback" coverage for children who lose health insurance coverage due to parental insurance coverage loss. One avenue to improvement of the State Children's Health Insurance Programs (SCHIP) would be to raise the parental income limit and/or reduce cost-sharing requirements. States' SCHIPs can operate as part of a State's Medicaid or as a stand-alone program: if the SCHIP is stand-alone, some Early Periodic Screening, Diagnosis, and Treatment (EPSDT) services are not covered, so SCHIPs linked to Medicaid protect children more. NPAF also asks that states consider what legislation or regulatory mechanism can identify and facilitate healthcare coverage of uninsured parents of children enrolled in SCHIPs. Comprehensive state coverage solutions will address both of these vulnerable populations and take a bold step in addressing the issue of the uninsured.

Model Legislation:

In the 2006 Legislative Session, Wyoming passed SB 58, expanding their SCHIP to cover parents of children enrolled in the program, subject to the approval of a waiver by the United States Secretary of HHS and available state and federal funding. The option to expand SCHIPs in this way is no longer available to states under the Deficit Reduction Act of 2005, unless, as in Wyoming's case, the proposal was made before the law was signed. Other states will need to find new ways to address this vulnerable population.

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MONITOR MEDICAID UNDER THE DEFICIT REDUCTION ACT OF 2005

Signed into law by President Bush on February 8, 2006, the Deficit Reduction Act (DRA) of 20055 includes 39 provisions that affect Medicaid and is expected to generate $39 billion of federal entitlement reductions over the 2006-2010 period and $99 billion by 2015. Medicaid spending is expected to decline by $11 billion over the first five years and by $43 billion over the first ten year period. The DRA 2005 requires increased fiscal integrity compliance by the States as well as by beneficiaries. In addition, the DRA 2005 expands many options available to States for covering the uninsured via mechanisms that increase beneficiaries' personal responsibility and encourages states to partner with the insurance industry in delivery of benchmark benefits programs. States may limit benefits and increase beneficiaries' cost sharing.

Where the Issue Stands:

The Deficit Reduction Act of 2005 process from becoming law to being interpreted by CMS and incorporated into State Medicaid plans is in relatively early stages. Most states now look to expand healthcare coverage to all citizens through the lens of what the DRA requires and provides as available options. Some provisions will allow advocacy groups to help ensure that the cuts do not adversely affect the neediest, and to promote structures for Medicaid program changes that yield long-term health benefits while adhering to the new fiscal constraints. Other provisions will enable advocacy groups only to comment on rules in the rule-making process.

Action needed:

NPAF advocates ensuring that individual State health policy climates, including the numbers of uninsured, the numbers of underinsured, and conditions under which individuals may receive needed assistance are understood and monitored as the new DRA 2005 rules are implemented. As opportunities arise to help analyze how access to healthcare can improved for individuals and families, existing State programs may require re-examination to ensure that the States implementing policy goals of the DRA do so in ways that clearly benefit individuals as well as States. Advocates have several mechanisms available for this level of action, including monitoring of the CMS Letters to Medicaid Directors; contributing the patient voice to policy proposals that help the state assist the uninsured and underinsured, and offering novel legislative proposals for ensuring quality-control in the States' plans for covering the uninsured.

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