a federal, state and local partnership for women in texas ~ october 2007 ~ evelyn delgado

A federal, state and local partnership for women in Texas~ October 2007 ~

Evelyn DelgadoAssistant Commissioner

Division of Family & Community Health Services

Breast & Cervical Cancer State Programs

• Early Detection • Early Treatment

Breast & Cervical Cancer Programs

Texas Average Annual Age-Adjusted Breast Cancer Incidence Rates, Female 2000-2004

117.3129.9

78.7

117.1

75.1

020406080

100120140

All Races Non-HispanicWhite

Hispanic Non-HispanicBlack

Other Race

Race/Ethnicity

Ra

te p

er

10

0,0

00

Breast Cancer in Texas and Harris County

Source: Texas Cancer Registry

Texas N=59,774Harris Co. N=9,340

Average Annual Age-Adjusted Breast Cancer Incidence Rates, Female 2000-2004 Texas and Harris County

117.3 129.9

78.7117.1

75.1

125.9146.9

69.6

126.894.7

0

50100

150

200

All Races Non-HispanicWhite

Hispanic Non-HispanicBlack

Other Race

Race/Ethnicity

Rat

e p

er

100,

000

Texas Harris County

Texas Average Annual Age-Adjusted Cervical Cancer Incidence Rates 2000-2004

10.3 8.8

14.612.7

7.5

0

5

10

15

20

All Races Non-HispanicWhite

Hispanic Non-HispanicBlack

Other Race

Race/Ethnicity

Ra

te P

er

10

0,0

00

Cervical Cancer in Texas and Harris County

Source: Texas Cancer Registry

Texas N=5,408Harris Co. N=911

Average Annual Age-Adjusted Cervical Cancer Incidence Rates 2000-2004 Texas and Harris County

10.3 8.8

14.612.7

7.511.3

8.3

18.3

13.410.3

0

5

10

15

20

All Races Non-Hispanic

White

Hispanic Non-Hispanic

Black

Other Race

Race/Ethnicity

Rate

Per

100,0

00

Texas Harris County

Mortality Rates in Texas

Source: Texas Cancer Registry

Breast N=12,465Cervical N=1,756

Average Annual Age-Adjusted Cancer Mortality Rates, Female, Texas, 2000-2004

24.5 24.9

18.2

36.8

8.73.4 2.7 4.6 6.2

2.105

10152025303540

All Races Non-Hispanic

White

Hispanic Non-Hispanic

Black

OtherRace

Race/Ethnicity

Ra

te p

er

10

0,0

00

Breast

Cervical

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

• 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

Early Detection: Breast & Cervical Cancer Services

Treatment: Enacting Legislation

U.S. Congress - 2000

Texas Legislature - 2001

• 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

Treatment: Medicaid for Breast & Cervical Cancer (2002 - 2007)(2002 - 2007)

Medicaid for Breast & Cervical Cancer

Texas Texas

(2002 – 2007)(2002 – 2007)

ClientScreened/Diagnosed

with cancer by a BCCS contractor with

Title XV funds.

Qualifies for MedicaidHHSC

Does Not QualifyOther services

All BCCS clients receive case management until resolution of the clinical outcome.

• 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

Medicaid for Breast & Cervical Cancer Today

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

BCCS Expansion

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 CancerToday

• Enrolled for full Medicaid coverage• 6 month recertification as long as

there is a continued need for treatment

Medicaid for Breast & Cervical CancerToday

MBCC Breast Qualifying DiagnosesToday

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 DiagnosesToday

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

Normal/Other

Cancer diagnosed

Screened/Diagnosed by a BCCS contractor

Traditional BCCS Client

Qualifies for Medicaid Does Not Qualify

BCCS contractor completes paperwork and sends to DSHS

HHSC

Medicaid Treatment

Case Management for access to treatment

DSHS Review

Routine Screening / Follow-Up

All BCCS clients receive case management until resolution of the clinical outcome.

MBCC Today, Referral

Screened/Diagnosed with cancer by a non-BCCS contractor

BCCS contractor completes forms and

sends to DSHS

HHSC

Medicaid Treatment

Client with Cancer Diagnosis

DSHSReview

May confer with BCCS contractor or needs to seek other treatment resources

Qualifies for Medicaid

Does Not Qualify

BCCS Contractor

All BCCS clients receive case management until resolution of the clinical outcome.

• BCCS conducts an assessment of medical, educational and essential support needs

Case Management for Treatment

• 2003 : 497 women • 2007: 678 women• 2008* Projected ~1,800• 2009* Projected ~3,000

Enrollment in Medicaid for Breast & Cervical Cancer

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 Hagerladavid.hagerla@dshs.state.tx.us

• Call DSHS (512) 458-7796