Medicaid Enrollment at Early Stage of Disease: The Breast and Cervical Cancer Prevention and Treatment Act in Georgia
Chien, Li-Nien, Adams, E. Kathleen, Yang, Zhou, Inquiry
This study linked data from the Georgia Comprehensive Cancer Registry to Medicaid enrollment and claims to test whether the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA), which provided a new and quicker pathway to Medicaid eligibility for low-income breast cancer patients, led to more patients enrolling at an early stage of disease. Results based on difference-in-differences analysis indicated that Georgia's BCCPTA increased by 11 percentage points the probability of breast cancer patients enrolling in Medicaid at an early stage (p = .024). This effect could mean more treatment options and higher survival rates for these patients.
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), funded by the Centers for Disease Control and Prevention, was designed to provide timely breast and cervical cancer screening and diagnostic services for uninsured and underinsured women with incomes generally below 250% of the federal poverty level (FPL) (Tangka et al. 2006). Since NBCCEDP received no funds for cancer treatment, uninsured women with those cancers could be easily left without adequate treatment. To fill this treatment gap, Congress passed the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in 2000, creating a new Medicaid option that allowed states to provide full Medicaid benefits to uninsured women who were under age 65, screened and/or diagnosed, and found in need of treatment for breast and cervical cancers or precancerous cervical conditions through the NBCCEDP providers (Centers for Medicare and Medicaid Services [CMS] 2005a). Our study state, Georgia, enacted its BCCPTA program, Women's Health Medicaid Program, in July 2001 (Georgia Department of Human Resources 2002).
The BCCPTA also gave states the flexibility to select broader screening scenarios for defining "screened under the program, NBCCEDP." Georgia was one of the 12 states that chose the most expansive coverage option by making women screened for and diagnosed with these cancers by any provider in the state eligible under the BCCPTA (CMS 2010). This option created greater access to Medicaid insurance for women with these cancers by expanding the network of qualifying screening providers. Data indicated that 75% of Georgia's BCCPTA enrollees were screened by non-NBCCEDP provider sites in 2003 (Adams et al. 2007). This aspect of the Georgia program, in addition to the availability of linked registry and claims data, made it a strong study state.
The BCCPTA was not only a disease-specific Medicaid expansion, but groundbreaking as the first effort to use a population-wide public health screening program (NBCCEDP) as a new pathway for bringing uninsured women into Medicaid. Moreover, the distinct characteristics of the BCCPTA, such as no direct income/asset test or waiting period for the uninsured, could be significant in getting uninsured cancer patients into Medicaid more quickly and, consequently, at an earlier stage of disease. In turn, this could lead to more effective treatment and better survival rates (Vernon et al. 1985; Machiavelli et al. 1989; Afzelius et al. 1994; Richards et al. 1999).
In this study we used data from the Georgia Comprehensive Cancer Registry (GCCR) linked to Medicaid enrollment and claims to address the following research questions:
 Did the implementation of the BCCPTA in Georgia increase the percentage of women with breast cancer enrolling in Medicaid at "early" (in situ and local) stage of disease?
 Did the change in "early" stage of Medicaid enrollment for "breast cancer" cases differ from "control cancer" cases for which eligibility was not altered by the BCCPTA?
Implementation of the BCCPTA in Georgia provides a quasi-experiment that allows us to test whether the change in the disease stage for low-income women entering Medicaid was different for women with breast cancer than for women with other types of cancer that were not affected by the BCCPTA. …