Breast and Cervical Cancer Treatment

Thousands of women each year are diagnosed with breast or cervical cancer. It is estimated that in 2007 in the U.S., 11,150 women will be diagnosed with cervical cancer and 178,480 women will be diagnosed with breast cancer, and about 44,130 women will die from both cancers combined. (1) The Report Card measures state commitment to fighting these diseases in three ways. First, states can exercise their option under the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (2) to provide medical assistance through full Medicaid benefits to uninsured women under age 65 who were screened through the Centers for Disease Control and Prevention's (CDC) National Breast and Cervical Cancer Early Detection Program (3) and that are in need of treatment. States receive enhanced federal matching funds for the provision of these services. Second, states can help breast cancer patients by mandating coverage for breast reconstruction after a mastectomy. Many patients have trouble getting coverage because some insurance companies deem it "cosmetic" surgery that is not medically necessary. Although a federal law was passed in 1998 to combat this practice, state laws add the strength of state enforcement mechanisms. (4) Third, states can mandate that insurance companies allow physicians, in consultation with their patients, to determine how long a woman stays in the hospital following a mastectomy, based on the patient's individual needs and circumstances. Such laws are necessary to address concerns that insurers have denied coverage beyond a pre-determined length of stay.

Data Points for this Issue:

Medicaid Coverage
Breast Reconstruction Surgery
Mastectomy Hospital Stays

Medicaid Coverage

	Strength Of Policy 2007	Change From 2004
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Meets Policy	51
Limited Policy	0
Weak Policy	0
No/Harmful Policy	0
Better	0
Worse	0
Same	51

Has the state exercised the basic option to provide Medicaid coverage for breast and cervical cancer treatment?

States that have enacted legislation, approved funding for the policy, or had a plan federally approved receive a "meets policy." Those that have not completed any of these three steps receive a "no policy."

Data Source: Medicaid Breast and Cervical Cancer Treatment Coverage, 2005.

Centers for Medicare and Medicaid services, "Breast and Cervical Cancer Prevention and Treatment Activity Map," December 2005, available at http://www.cms.hhs.gov/MedicaidSpecialCovCond/
02_BreastandCervicalCancer_PreventionandTreatment.asp
#TopOfPage, accessed May 3, 2007.

Breast Reconstruction Surgery

	Strength Of Policy 2007	Change From 2004
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Meets Policy	38
Limited Policy	0
Weak Policy	0
No/Harmful Policy	13
Better	0
Worse	1
Same	50

Does the state require private insurers to cover breast reconstruction surgery after mastectomy?

States receive a "meets policy" if they require coverage of reconstructive surgery with no restrictions. States receive a "limited policy" if they only require coverage when medically necessary. States receive a "weak policy" if they only require insurers to offer coverage of breast reconstruction surgery as a benefit in employer-sponsored insurance plans, but have not required that it be a mandated benefit in all of these insurance plans. States receive a "no policy" if they do not mandate any coverage of reconstructive breast surgery.

Data Source: Breast Reconstruction Surgery, 2006

The Henry J. Kaiser Family Foundation, "State Mandated Benefits: Reconstructive Surgery after Mastectomy, 2006," available at http://www.statehealthfacts.org/comparetable.jsp?cat=10&ind=490, accessed May 24, 2007.

Mastectomy Hospital Stays

	Strength Of Policy 2007	Change From 2004
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Meets Policy	9
Limited Policy	10
Weak Policy	0
No/Harmful Policy	32
Better	0
Worse	0
Same	51

Does the state require private insurers to cover hospital stays following a mastectomy?

States that mandate the coverage of physician-determined length of stay post-mastectomy receive a "meets policy." States receive a "limited policy" if they require private insurers to cover only a minimum length (usually 48 hours) hospital stay following a mastectomy. States receive a "no policy" if they do not have any protections for patients who have mastectomies.

Data Source: Mastectomy Hospital Stays, 2006

The Henry J. Kaiser Family Foundation, "State Mandated Benefits: Inpatient Mastectomy Stay, 2006," available at http://www.statehealthfacts.org/comparetable.jsp?cat=10&ind=489, accessed May 22, 2007.

1. American Cancer Society, Estimated New Cancer Cases and Deaths by Sex for Ass Sites, US, 2007 (Atlanta: American Cancer Society, 2007), available at http://www.cancer.org/downloads/stt/CFF2007EstCsDths07.pdf.

2. The Breast and Cervical Cancer Treatment Act of 2000 gives states the option of providing Medicaid coverage to low-income women screened and diagnosed with breast and cervical cancer through the Centers for Disease Control and Prevention's Breast and Cervical Cancer Early Detection Program. 42 U.S.C. § 300n.

3. The National Breast and Cervical Cancer Early Detection Program provides free breast and cervical cancer screening and follow-up diagnostic services to uninsured or low-income women, but does not provide treatment to those found to have either disease. Breast and Cervical Cancer Mortality Prevention Act of 1990, 42 U.S.C. § 300k.

4. The Women's Health and Cancer Rights Act of 1998, 29 U.S.C. § 1185b, 42 U.S.C. §§ 300gg-6, 300gg-52.