A federal, state and local partnership for women in Texas ~ October 2007 ~ Evelyn Delgado
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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 State Programs
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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. - PowerPoint PPT Presentation
Transcript of 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 [email protected]
• Call DSHS (512) 458-7796
