Cancer policy in limbo | The Post and Courier, Charleston SC ...

Tuesday, February 14, 2012

Photo by Grace Beahm

Raymond Johnson of Cross initially was denied Medicaid benefits after being diagnosed with breast cancer because he was a man. Eventually, the state Medicaid agency said it would cover Johnson?s care even if the federal department failed to contribute its standard three-to-one dollar match. The ACLU is asking the federal government to require coverage regardless of gender.

The ACLU wants the federal Medicaid agency to require states to cover uninsured male breast cancer patients who now are ineligible for benefits because of their gender alone.

The group's Feb. 2 letter to the U.S. Centers for Medicare & Medicaid Services said male patients legally should be entitled to benefits when they meet all other eligibility criteria for the government-funded health insurance program for the poor.

Medicaid coverage for men with breast cancer became an issue in August when The Post and Courier reported on 26-year-old Cross resident Raymond Johnson, who was denied benefits for his treatment because he is a man. Following that report, the state Medicaid agency said it would cover Johnson's care even if the federal department failed to contribute its standard three-to-one dollar match.

Since then, the federal agency has paid its share for the South Carolina man's coverage, state Medicaid spokesman Jeff Stensland confirmed last week. In November and December, the state approved two additional male breast cancer patients for coverage, Stensland said.

But because the federal Medicaid agency never offered a policy statement, it is unclear what would happen to men in similar cases in other states.

"CMS is working together with other agencies within the Department of Health and Human Services to develop the best policy that complies with statutory and other legal requirements," the Centers for Medicare & Medicaid Services said in a statement to The Post and Courier. "Our aim is to work to provide coverage for breast cancer treatment for men and women with Medicaid if they need it."

The ACLU said it has not received a response to its letter, which cited the newspaper's August reports about Johnson.

"We urge CMS to revisit its policy and issue guidance to the state Medicaid agencies, obligating them to extend Medicaid benefits to men who are diagnosed with breast cancer and otherwise meet the age and insurance criteria," the group's legislative office director, policy counsel and a staff attorney wrote. "The government, as a matter of law, cannot deny life-saving treatment to male breast cancer patients based only on their sex."

The ACLU said denying benefits based on gender violates the equal protection guarantee of the U.S. Constitution and the anti-discrimination provision of the 2010 Patient Protection and Affordable Care Act.

Reach Renee Dudley at 937-5550 or on Twitter @renee_dudley.

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Source: http://www.postandcourier.com/news/2012/feb/14/cancer-policy-in-limbo/

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