Below is the testimony of Hillary Clarke of the American Cancer Society who spoke on 1/20/11 in Buffalo before the New York State Medicaid Redesign Team. As part of her presentation, Ms. Clarke distributed a handout on MassHealth ROI Calculations. That sheet is available here in PDF format >>>
January 20, 2011
Thank you for the opportunity to appear today.
As you know, Medicaid was designed as a safety net system to serve those living under the poverty line. Yet complex rules currently limit eligibility to people who fall into certain categories, such as pregnant women, children, the disabled, some parents, and women with breast and cervical cancer. And restrictions on covered services too often discourage efforts to prevent disease, leading to costlier and more adverse health outcomes down the road.
The American Cancer Society strongly applauds provisions in the Affordable Care Act designed to address some of these shortcomings, and we look forward to working with state lawmakers to maximize their impact as the ACA is implemented here in New York. The Society is heavily invested in the conversation around Medicaid redesign because Medicaid and its related products are the primary source of health care for over 15% of cancer patients in New York.
Increasing access to care for our state’s most vulnerable populations is a critical step in the fight against cancer. That’s why we support new rules expanding Medicaid eligibility to 133% of the Federal Poverty Level for everyone beginning in 2014. We will be closely monitoring the state’s efforts to design “benchmark” benefit plans for our newly eligible populations.
Beginning in 2013, the law also gives states the option to include preventive services graded “A” or “B” by the U.S. Preventive Services Task Force (USPSTF) in their traditional Medicaid program benefits. These services will be mandated in all plans purchased by individuals and groups through the Health Insurance Exchange. States that provide these services without cost sharing to Medicaid clients will receive a 1% increase in the Federal Medical Assistance Percentage (FMAP).
In New York State, approximately one-third of adult Medicaid recipients smoke. Because annual smoking-related Medicaid expenditures here in New York total $5.4 billion, tobacco is a fiscal challenge for our state, as well as a health issue. While New York provides partial smoking cessation coverage in Medicaid, these efforts are limited by the absence of smoking cessation counseling, except for neo-natal women and adolescents, the presence of co-payments, and restrictions placed on the number of courses and the length of treatment.
Thus potential quitters encounter bar¬riers to getting the help they need even in a state like ours where Medicaid covers cessation treat¬ments. Requiring co-payments for medication, especially of the low-income Medicaid population, discour¬ages smokers from seeking treatment or refilling their prescriptions. Co-payments should not be charged or should be as low as possible.
Further, most tobacco users will make several quit attempts before being successful. Any arbitrary limit on the number of courses and the length of treatment can contribute to a failed quit attempt or a relapse, which is only self-defeating to the state. The medication limit is particularly an issue for those with the most severe and chronic tobacco addiction such as those with substance abuse and serious mental illness. If one course is prescribed but not tolerated, then a patient has only one course left for the entire year. In addition, those with high levels of nicotine addiction often need multiple cessation medications that complement one another such as a nicotine replacement product and Zyban. The literature suggests that highly addicted individuals are often under-medicated which undermines a patient’s ability to quit smoking. There are enough barriers to treating this costly addiction in this challenging population without arbitrarily tying the hands of a physician on evidence-based, cost effective care.
Under the Affordable Care Act, all state Medicaid programs must cover the full-range of cessation services for pregnant women without cost-sharing requirements. We urge New York to apply this same standard to all of its traditional Medicaid beneficiaries as soon as possible.
Massachusetts has made a significant investment in reducing smoking among its Medicaid population. And we know it’s working. Smoking rates for recipients decreased 26% in the first 2½ years, saving the state more than $10 million in hospitalization costs. A $5.1 million investment in cessation efforts returned $2 for every dollar spent. And that’s in the short run. Savings will continue to accrue and increase as time goes on. I have a fact sheet I am submitting with my testimony that provides additional information about the Massachusetts experience.
Similarly, while New York covers at-home testing kits for colorectal screening and, in some cases, can cover colonoscopy for people with a strong family history of colorectal cancer or personal history, we do not currently cover the full-range of colorectal cancer screening tests according to USPSTF guidelines.
In fact, New York’s record on getting Medicaid beneficiaries in for needed screenings is not good. Only 40% of Medicaid enrollees ages 50 to 64 received recommended colorectal cancer screening in the past 10 years. 17% of Medicaid-enrolled women ages 18 to 64 have not received a Pap test in the past three years. And only 56% of Medicaid-enrolled women ages 40 to 64 received a mammogram in the past two years.
Yet, when given access to preventive services programs, Medicaid beneficiaries participate at high rates. That’s why we applaud new provisions in the Affordable Care Act designed to prevent disease in these low-income and vulnerable populations, and urge New York to place a high priority on early detection of cancer as part of any planned Medicaid redesign.
Finally, even after the health care law is fully implemented in 2014, thousands of New Yorkers still will lack insurance coverage. Maintaining a strong NYS Cancer Services Program, offering no cost breast, cervical and colon screening to the uninsured, is critical. State funding levels have fluctuated in recent years and the program must be strongly supported and adequately funded. While this service is not funded through Medicaid, please consider this important point, as well as the aforementioned recommendations in your future deliberations.
Thank you.