History and Background of the Medicaid Breast and Cervical Cancer Treatment Program

(as of February 2008)

Origin of the Policy

The Breast and Cervical Cancer Mortality Prevention Act (P.L. 101-354), signed into law in 1991, authorized the Centers for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to provide free screening services for low-income women with no health insurance. Unfortunately, the NBCCEDP did not include a mechanism for ensuring that women diagnosed with cancer through the program had access to treatment services. As a result, many of these women found themselves scrambling to find ways to pay for their treatment. The NBCCEDP helped these women find treatment coverage through charitable contributions, but this system was often unreliable and rapidly deteriorating.

The idea for a potential solution to this problem came from the National Breast Cancer Coalition (NBCC) through its grassroots network. NBCC recognized the need for women diagnosed with federal dollars to have access to treatment and suggested Medicaid as a possible source to cover the cost of their care. This idea resulted in the Breast and Cervical Cancer Treatment Act (P.L. 106-354). NBCC successfully advocated for enactment of this legislation which established the Breast and Cervical Cancer Treatment Program (BCCTP). This Program, available to all states, provides Medicaid coverage to low-income, uninsured or underinsured women diagnosed with breast and cervical cancer through the federal screening program.

This background document describes the Act; explains how the law was enacted and what states need to do to participate in the Program; and highlights work that still needs to be done.

The Act

On October 24, 2000, the Breast and Cervical Cancer Treatment Act was signed into law. This Act gives states the option of providing Medicaid coverage to low-income, uninsured and underinsured women, under 65 years of age, who have been screened and diagnosed through the NBCCEDP, and are in need of breast or cervical cancer treatment. Each state that opts in receives an enhanced match from the federal government, equal to its State Children’s Health Insurance Program (SCHIP) match, which funds 65%-83% of the total program cost. States are also given the option to extend a presumptive eligibility procedure to applicants to facilitate prompt enrollment and immediate access to treatment. Presumptive eligibility allows women who appear to be eligible for Medicaid to enroll in BCCTP and receive services on a temporary basis while their Medicaid applications are processed.

The Road to Enactment

From 1997 until the Treatment Act became law, NBCC led the fight to enact this legislation. NBCC advocates secured an overwhelming majority of cosponsors of the Breast and Cervical Cancer Treatment Act, convinced Committees to hold hearings and markups, and persuaded Congressional leaders to bring the bill to the Floor. NBCC also successfully urged the Administration to include funding for the bill in the President's fiscal year 2001 budget.

While overwhelming support in Congress (the bill passed 421-1 in the House of Representatives, and unanimously in the Senate) may suggest that this effort was accomplished easily, that is far from the case. Passage of this important Act was an uphill battle. NBCC’s grassroots faced many setbacks in the four long years it took to get this bill passed – some that seemed insurmountable. NBCC’s success in ensuring that low-income women diagnosed with breast cancer have access to the treatment they deserve demonstrates the power of strategic and tireless grassroots advocacy.

In a study of the passage of the Breast and Cervical Cancer Treatment Act, Paula M. Lantz, Ph.D. et.al. highlighted the work of NBCC with the following statement:

“The NBCC was the key organization in the framing of the problem, in the formulation and promotion of the policy solution that was ultimately adopted, and in the political process . . . The key advocacy coalition in this story, the NBCC, had the combination of a viable policy idea, political savvy, lobbying expertise, loyal grassroots members with the ability to mobilize resources quickly, and credibility with Congress stemming from several policy successes.¹ ”

State Participation in the Treatment Program

After the bill was signed into law, NBCC’s attention and efforts were focused on working with individual states to ensure that they took up the new Medicaid option, the Breast and Cervical Cancer Treatment Program. NBCC’s grassroots network worked with their Members of Congress, governors, state legislators, CDC’s Early Detection Program officials, and state Medicaid directors to engage states in the implementation process. This far-reaching initiative revealed that while the key steps in the process are similar for all states, no two states share the same story.

Any state that elected to participate in the new Medicaid option was required to submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) for its approval. Only when a state’s SPA was approved by CMS had it completed the necessary steps to receive its enhanced federal share of payment for Program costs.

In addition, all states must provide funding (cash or an in-kind match) to cover the state share of Program costs. Most states needed to appropriate new funding, while a few states were initially able to use funding already allocated to the state health or Medicaid Department. For some states, an SPA and the allocation of funding were the only requirements to participate in the new option. States that opt in this way are considered to have opted in administratively, since the Governor could approve the policy without having to sign authorizing legislation that would need to pass through the state legislature. However, most states had to enact authorizing legislation in order to opt into the Treatment Program.

Since the enactment of the Treatment Act, every state and the District of Columbia have adopted the Treatment Program. Additionally, 22 states have elected the presumptive eligibility option.² Many policy-makers, public health officials and leaders in local and national health care communities have commented that this progress is unique. For example, the Federal Funds Information for States (FFIS) noted that states were taking on the Medicaid option at “a historically rapid rate,” and attributed this phenomenon partly to “coordinated efforts by breast cancer survivors and their allies to persuade state officials to adopt it.³” The National Breast Cancer Coalition’s incredible grassroots advocates have been credited numerous times as the primary leaders of this effort.

Continuing Efforts

It is important that while we celebrate the passage of the Breast and Cervical Cancer Treatment Act and the rapid progress we made in encouraging state participation in this Program, we do not lose sight of the fact that this is only a first step. While the Breast and Cervical Cancer Treatment Act provides coverage for underserved women who qualify for the NBCCEDP, there are many other women who still do not have access to early detection and treatment services. Furthermore, there are still millions of people in this country that are uninsured or underinsured who lack access even to basic health care services. We must continue to work together to ensure that all men, women, and children have access to the high quality health care they deserve.

NBCC’s grassroots advocates will remain diligent in their efforts to ensure that states continue this Program and that the Program thrives in future years.

¹Lantz PM, Weisman CS, Itani Z. A disease-specific Medicaid expansion for women: The Breast and Cervical Cancer Prevention and Treatment Act of 2000. Women’s Health Issues 2003; 13: 79-92.

²The following states have presumptive eligibility: California, Colorado, Connecticut, Delaware, Georgia, Iowa, Idaho, Minnesota, Missouri, Mississippi, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, New York, Oregon, Rhode Island, Tennessee, Texas, Wisconsin, West Virginia.

³Federal Funds Information for States. Issue Brief 07-02: Update on Medicaid Breast and Cervical Cancer Treatment. January 11, 2007. Available at: http://www.ffis.org/172101/98422.html.