Komen Orange County Leads Coalition to Victory on Mammography Coverage

Komen Orange County Leads Coalition to Victory on Mammography Coverage!

Swift action by Susan G. Komen Orange County has resulted in a reversal of a potentially devastating MediCal policy revision that would have stopped paying for breast cancer screenings for MediCal eligible California women between the ages of 40 and 50 years old.

Komen Orange County mobilized a coalition of women’s health advocacy organizations from across California to act on the impending changes to Medi-Cal mammography guidelines and convince the Department of Health Care Services to immediately stop implementation. In less than 24 hours after a conference call meeting with representatives from Komen Orange County and other advocates, Department officials reversed their decision and agreed to revert the Medi-Cal policy back to allowing breast cancer screenings beginning at age 40.  A Medi-Cal Newsflash and provider bulletin will be released this week according to Cynthia Owens, Acting Division Chief of the Medi-Cal Benefits Division of the California Department of Health Care Services.

This is a major victory maintaining coverage of breast health care and screening for women in California.

Komen Orange County is also advocating for the passage of AB1795 that would provide coverage of medical treatment under the Breast and Cervical Cancer Treatment Program (BCCTP) for the entire time that a woman needs treatment due to a diagnosis of breast cancer or cervical cancer, as long as the individual continues to meet all other eligibility requirements. Currently under the state BCCTP, treatment coverage is limited to 18 months for breast cancer and 24 months for cervical cancer. It also includes a provision that denies coverage to a woman who is re-diagnosed with the same cancer in the same tissue. The federal BCCTP has no time limit of coverage and covers a re-diagnosis of cancer.

AB1795 would also expand eligibility for breast cancer screening under the California Every Woman Counts (EWC) program to include symptomatic women regardless of their age, thus including women under the age 40.   The Every Woman Counts (EWC) program provides cancer screening services to low-income uninsured or underinsured women. Currently, the EWC program provides breast cancer screening services only for women ages 40 years and older. Thus uninsured or underinsured women presenting breast cancer symptoms, who are under the age of 40, have to find care elsewhere. This makes it more difficult to receive prompt diagnosis and treatment.

Komen Orange County has been filling this gap locally for over 20 years utilizing funds raised by the Orange County Race for the Cure to provide the Komen Fund for Breast Health Care to pay for medically necessary diagnostic procedures for uninsured, low income young women who have a suspicious breast issue and are excluded from the EWC program.  Thousands of young women have had their diagnostic tests paid for by the Komen Fund to determine if they do, or do not, have breast cancer.  When a breast cancer is detected, women are immediately navigated into treatment.

AB 1795 will help ensure that all women have timely access to receive the necessary services to detect and treat their cancers early. This bill allows low-income women in California who are uninsured or underinsured to receive complete treatment for breast and cervical cancer, provides that she is not turned away if she is later diagnosed with the same cancer, and allows women under age 40 who are symptomatic for breast cancer to receive necessary screening services.

Komen OC representatives and young women who have been shutout of the EWC program will be traveling to Sacramento on March 8th for a legislative press conference in support of AB1795.