Transcript Medicaid for Breast & Cervical Cancer Texas

Breast & Cervical Cancer
State Programs
A federal, state and local partnership for women in Texas
~ October 2007 ~
Evelyn Delgado
Assistant Commissioner
Division of Family & Community Health Services
Breast & Cervical Cancer Programs
• Early Detection
• Early Treatment
Breast Cancer in Texas and
Harris County
Average Annual Age-Adjusted Breast Cancer Incidence Rates,
Texas Average Annual Age-Adjusted
Cancer
FemaleBreast
2000-2004
Texas and Harris County
140
120
100
80
60
40
20
0
200 129.9
117.1
146.9
129.9
125.9
117.3 78.7
75.1
150
100
50
All Races
Non-Hispanic
Hispanic
Non-Hispanic Other Race
Black
0 White
Race/Ethnicity
All Races Non-Hispanic
White
117.3
Rate per
100,000
Rate per 100,000
Incidence Rates, Female 2000-2004
Texas
Harris County
Texas N=59,774
Harris Co. N=9,340
Source: Texas Cancer Registry
117.1126.8
78.7 69.6
Hispanic
75.1
94.7
Non-Hispanic Other Race
Black
Race/Ethnicity
Cervical Cancer in Texas and
Harris County
Average Annual Age-Adjusted Cervical Cancer
Incidence Rates 2000-2004 Texas and Harris County
20
15
10
5
0
Rate Per 100,000
Rate Per 100,000
Texas Average Annual Age-Adjusted Cervical Cancer
Incidence Rates 2000-2004
18.3
20
14.6
14.6
10.3 11.3
8.8
15
10.3
12.7
8.8 8.3
10
5
All Races
Non-Hispanic
White
0
Hispanic
Non-Hispanic
Black
7.5
7.5
10.3
Other Race
Race/Ethnicity
All Races
NonHispanic
White
Hispanic
Race/Ethnicity
Texas
12.7 13.4
Harris County
Texas N=5,408
Harris Co. N=911
Source: Texas Cancer Registry
NonHispanic
Black
Other Race
Mortality Rates in Texas
Rate per 100,000
Average Annual Age-Adjusted Cancer Mortality
Rates, Female, Texas, 2000-2004
40
35
30
25
20
15
10
5
0
36.8
24.5
24.9
Breast
18.2
3.4
All Races
6.2
4.6
2.7
NonHispanic
White
Hispanic
NonHispanic
Black
Race/Ethnicity
Breast N=12,465
Cervical N=1,756
Source: Texas Cancer Registry
Cervical
8.7
2.1
Other
Race
Ana Sierra - Austin, TX 2007
Early Detection:
Breast & Cervical Cancer Services
• Title XV Federal funding - $6.4 million/year for the
screening of the target population (uninsured women most
at risk)
• State - DSHS responsibilities
– Provide statewide coverage
– Data Management & Surveillance
– Professional Education
– Quality Assurance
Early Detection:
Breast & Cervical Cancer Services
• BCCS focuses on high
priority populations
- Breast (50+)
- Cervical (18-64)
- Any woman with an
abnormal screening
Early Detection:
Breast & Cervical Cancer Services
• Local Community Responsibilities
– Screening & Education
– Case Management of women with abnormal
findings
– Outreach
– Partnerships
Treatment: Enacting Legislation
U.S. Congress - 2000

Texas Legislature - 2001
Treatment:
Medicaid for Breast & Cervical Cancer (2002 - 2007)
• Medicaid coverage for women diagnosed
by Texas BCCS with Title XV funds and who
need treatment of breast or cervical
cancer
- DSHS confirms diagnoses and BCCS
enrollment
- HHSC processes Medicaid enrollment
and re-certification
Medicaid for Breast & Cervical Cancer
Texas
(2002 – 2007)
Qualifies for Medicaid
HHSC
Client
Screened/Diagnosed
with cancer by a
BCCS contractor with
Title XV funds.
Does Not Qualify
Other services
All BCCS clients receive case management until
resolution of the clinical outcome.
Medicaid for Breast & Cervical Cancer
Today
• 80th Texas Legislature authorized the broadest
expansion allowable under federal guidance
• Additional state funds for treatment and diagnosis
– $14.9 million - Medicaid
– $5.2 million - BCCS
• BCCS contractors are the primary contacts for assisting
women and providers
• BCCS contractors coordinate with local providers and
HHSC/Medicaid
BCCS Expansion
1. Current BCCS contractors with capacity
will offer services in new clinics
2. DSHS will release a new request for
proposals targeting those counties that are
not currently served or underserved.
•
•
Will be released by early November.
New contracts will begin January 1, 2008
Medicaid for Breast & Cervical Cancer
Today
Eligibility:
• Uninsured, no creditable insurance
coverage
• U.S. citizen or qualified immigrant
• Income eligible (200% FPL)
• A qualifying diagnosis
• Under 65
• Texas Resident
Medicaid for Breast & Cervical Cancer
Today
• Enrolled for full Medicaid coverage
• 6 month recertification as long as there
is a continued need for treatment
MBCC Breast Qualifying Diagnoses
Today
A qualifying pre-cancerous breast diagnosis* is biopsy confirmed:
◄Ductal carcinoma in situ (DCIS)
Qualifying breast cancer diagnoses must be biopsy-confirmed.
1. Ductal Carcinomas:
◄Invasive
◄Comedo
◄Inflammatory
◄Medullary
◄Mucinous (colloid)
◄Papillary or Micropapillary
◄Scirrhous
◄Tubular
◄Cribiform
2. Lobular Carcinoma:
◄Invasive
3. Nipple Carcinoma:
◄Paget’s disease
4. Other Carcinomas
(For the full list visit: ww.dshs.state.tx.us/chscontracts/pdf/MBCCQualifyingDx91807.pdf)
MBCC Cervical Qualifying Diagnoses
Today
Qualifying pre-cancerous cervical diagnoses are biopsy-confirmed:
◄CIN III
◄Severe dysplasia
◄Carcinoma or adenocarcinoma in situ
Qualifying malignancies of the cervix are biopsy-confirmed:
◄Squamous cell carcinoma
◄Adenocarcinoma
◄Invasive endocervical adenocarcinoma
◄Small cell carcinoma
◄Invasive cervical cancer
◄Invasive neoplasm
◄Malignant neoplasia
◄Melanoma
◄Sarcoma
◄Glassy cell
◄Adenoid cystic
◄Adenosquamous carcinoma
MBCC Today, BCCS Enrolled
Traditional BCCS Client
Screened/Diagnosed by a BCCS contractor
Normal/
Other
Routine Screening /
Follow-Up
Cancer
diagnosed
Qualifies for
Medicaid
BCCS contractor completes
paperwork and sends to DSHS
Does Not Qualify
Case Management for
access to treatment
DSHS Review
HHSC
Medicaid Treatment
All BCCS clients receive case management until
resolution of the clinical outcome.
MBCC Today, Referral
Client with Cancer Diagnosis
Screened/Diagnosed with cancer
by a non-BCCS contractor
Qualifies for
Medicaid
BCCS Contractor
Does Not Qualify
May confer with BCCS
contractor or needs to seek
other treatment resources
BCCS contractor
completes forms and
sends to DSHS
DSHS
Review
HHSC
Medicaid Treatment
All BCCS clients receive case management until
resolution of the clinical outcome.
Case Management for Treatment
• BCCS conducts an
assessment of
medical, educational
and essential
support needs
Enrollment in Medicaid for
Breast & Cervical Cancer
•
•
•
•
2003 : 497 women
2007: 678 women
2008* Projected ~1,800
2009* Projected ~3,000
A Federal, State, and
Local Partnership
Challenges
• Some women will not qualify but need still
need treatment:
- Non-qualifying diagnosis
- Immigration status
• Education and Outreach on new policies
• Covering both cervical cancer and breast
cancer
How can you help?
•
•
•
•
•
Know your local BCCS provider
Talk to your provider
Identify ways to help those that need support
Let us know what works; what doesn’t
Call us if you have questions
For More Information
• To find a BCCS clinic call 211 or visit
the BCCS website:
www.dshs.state.tx.us/bcccs
• Email David Hagerla
[email protected]
• Call DSHS (512) 458-7796