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Kathleen A. Maloy, JD, PhD, Center for Health Services Research and Policy, The George Washington University, 2021 K Street NW Suite 800, Washington, DC 20006, 202-530-2368, kmaloy@gwu.edu, Sarah Blake, MA, The Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E., Room 672, Atlanta, GA 30329, and Chaya Merrill, MPH, Department of Health Policy, The George Washington University, 2021 K Street, NW, Suite 800, Washington, DC 20006.
The BCCPTA established a new coverage option under Medicaid that permits states to extend Medicaid to uninsured women under 65 with breast and/or cervical cancer screened and diagnosed through the CDC-funded National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This coverage option is groundbreaking in its use of population-wide public health screening program as pathway for publicly funded health insurance. As states did not begin to implement BCCPTA until 2001, little is known about states’ implementation experiences and how women’s access to breast and cervical cancer treatment might be affected. The research objectives are to (1) describe and evaluate initial BCCPTA implementation, and (2) design research to measure and assess the effect of BCCPTA on health outcomes for women with breast and cervical cancer.
Case study methods were used to examine sixteen states that were among the first to implement BCCPTA. Data collection, conducted during July through December 2002, included structured interviews with key stakeholders, including state Medicaid officials, Title XV (i.e., NBCCEDP) grantees, community/advocacy organizations, and document review. Data collection and analysis focused on (1) designs of states’ Medicaid expansions, (2) collaboration between Medicaid and Title XV officials; (3) development of BCCPTA Medicaid enrollment procedures; (4) effect of BCCTPA implementation on Title XV agencies; and (6) states’ experiences in implementing BCCPTA.
The principal findings include: (1) Relatively smooth implementation with states using existing NBCCEDP provider screening networks; (2) Wide range across states of enrollment procedures and redetermination practices. (2) Substantial variation across states in their experiences with Medicaid enrollment and expenditures versus prior estimations/expectations; (3) Notable and variable impact on the activities of Title XV agencies; and (4) Uncertainty about long-term costs associated with BCCPTA coverage due to early stage of implementation.
The conclusions include: (1) Early success in enrolling women in BCCPTA Medicaid, (2) Effective collaboration between Medicaid and Title XV to implement this unique coverage expansion, and (3) Substantial state support for BCCPTA. Study findings suggest that screening programs can be an effective pathway to publicly-funded insurance coverage (i.e., Medicaid). Uncertainty about costs may present longer-term challenges to ongoing implementation.
Study findings provide the essential first step toward conducting impact research that will (1) evaluate the effectiveness of BCCPTA in improving the ability of uninsured women with breast or cervical cancer to secure earlier and better treatment and, thereby, to experience improved outcomes, and (2) assess whether using prevention programs as a pathway for publicly-funded insurance coverage promotes access to quality care and improves health outcomes.
Learning Objectives:
Keywords: Breast Cancer Programs, Women's Health
Related Web page: www.cms.hhs.gov/bccpt/default.asp
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
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