Breast and Cervical Cancer Prevention and Treatment Act of 2000:
Providing Treatment for Uninsured Women

Jessica Luna, J.D. Candidate

Breast cancer is the most common form of cancer, besides skin cancer, and is the second-leading cause of cancer related death. It is estimated that almost 200,000 women will be diagnosed with breast cancer this year and that over 40,000 will die of it. Although cervical cancer is not as prevalent as breast cancer, it is estimated that about 4,400 women will die of cervical cancer this year alone. A disproportionate number of these deaths occur among women of racial and ethnic minority and low-income groups, many of whom are uninsured. http://www.cdc.gov/cancer/nbccedp/about.htm. Two factors contribute to the disproportionate number of uninsured women that die of breast and cervical cancers: failure to detect the cancer early and the unavailability of treatment.

Uninsured women are less likely to be diagnosed at an early stage of the cancer. Early screening and detection is very important for beating breast or cervical cancer. For example, timely mammograms for women over 40 could prevent between 15% and 30% of deaths due to breast cancer. (See http://www.cdc.gov/cancer/nbccedp/about.htm.) Prior to 1990, however, uninsured women were less likely to receive the necessary breast and cervical cancer screenings than insured women.

In 1990, Congress recognized this problem and responded by enacting the Breast and Cervical Cancer Mortality Prevention Act of 1990. 42 U.S.C. § 300k. This law established the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC). The function of the NBCCEDP is to provide public education and outreach, breast and cervical cancer screening, and post-screening diagnostic services. The NBCCEDP operates in all 50 states and has been very successful in increasing the number of women who receive these invaluable services. Over 2.7 million screening examinations have been performed under the program since its inception in 1990, and thousands of women who may have previously gone undiagnosed have been diagnosed and given referrals for treatment. http://www.cdc.gov/cancer/nbccedp/about.htm.

While the efforts of the NBCCEDP greatly improved the chances of survival for many women, it was soon clear that it was not enough. Until recently, the services provided to uninsured women diagnosed with cancer ended with the referral for treatment. The Breast and Cervical Cancer Mortality Prevention Act of 1990 did not authorize the CDC to provide or pay for the treatment itself. Unfortunately, this placed many uninsured women in the predicament of having been diagnosed with cancer but being unable to afford to get treatment.

Last year, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (Act), which became effective on October 4, 2000, in order to remedy the problem. P.L. 106-354 (http://cdc.gov/cancer/nbccedp/law.htm). The Act states that it "amends Title XIX of the Social Security Act to provide medical assistance for certain women screened and found to have breast or cervical cancer under a federal screening program." In order to achieve this goal, the Act authorizes states to provide full Medicaid benefits to uninsured women under the age of 65 who have been screened under the NBCCEDP and are in need of treatment for breast or cervical cancer. P.L. 106-354(a)(2). Treatment is provided for women with pre-cancerous conditions and cancer in early stages, as well, and states are allowed to provide presumptive eligibility to qualified women to ensure treatment begins early. Coverage is to be provided throughout the woman’s course of treatment, and no limit is placed upon the number of periods an eligible woman may receive treatment. Further, states are given the authority to cover women that qualify under the Act regardless of income. See http://www.hcfa.gov/medicaid/sho01041.htm.

Although the states are not required to participate in the program created by the Breast and Cervical Cancer Prevention and Treatment Act of 2000, there is an incentive for states that do participate. States that offer the benefits will receive an enhanced matching Medicaid rate for the women who are enrolled. Rhode Island, New Hampshire, West Virginia, and Maryland were the first states to apply, and be approved, to participate in the program. In June, six more states were approved for participation. These were Utah, Idaho, Illinois, South Dakota, Montana, and Indiana. See http://cancer.med.upenn.edu/cancer_news/reuters/2001/jun/20010601manc001.html or http://www.hhs.gov/news. Almost all other states have taken actions toward participation, either through the introduction or enactment of legislation, revision or enactment of regulations, or the submission of revised Medicaid plans. Texas has done so by enacting S.B. 532, which will be effective on September 1, 2001. See http://www.senate.gov/`appropriations/labor/testimony/seffrin.htm. The U.S. Department of Health and Human Services Secretary Tommy Thompson announced that he would write letters to the governors of the remaining states "to encourage them to take advantage of this new program." http://imaginis.net/breasthealth/news/news6.12.01.asp.


 
States where actions have been taken, including the introduction or enactment of legislation, revision or enactment of regulations, or the submission of revised Medicaid plans. States that have completed all steps required to accept the new Medicaid option.

(Map was last updated on June 19, 2001 and is taken from the CDC web page at http://www.cdc.gov/cancer/nbccedp/law106-354.htm. Also available on that page are links to bills related to the program for each state.)

08/26/01