The effect of the breast and cervical cancer prevention and treatment act on medicaid disenrollment

Background: The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) of 2000 created a new Medicaid option that allowed states to expand coverage to previously uninsured low-income women screened by certain public providers and found in need of treatment for those cancers. States also had the flexibility to allow any provider to screen for this new eligibility category and BCCPTA women were made eligible for all Medicaid services for the duration of their treatment. We have assessed the effect of this new program on the disenrollment patterns of women with breast/cervical cancer versus those with control cancers pre- and post-BCCPTA in Georgia. The post-BCCPTA period analyzed here was one in which Georgia BCCPTA women could self-report that they were in active treatment and, hence, still eligible. Methods: The Georgia Comprehensive Cancer Registry (1999-2004) was linked to Medicaid enrollment files (1998-2005) to identify female Medicaid enrollees aged under 65 and enrolled in Medicaid at or after being diagnosed with breast (n = 2,265), cervical (n = 439) or one of five control cancers (n = 700). The rate of disenrollment (per 100 person-months) was computed for each cancer group pre- versus post-BCCPTA. We employed difference-in-differences analysis to adjust for any temporal changes other than BCCPTA that could affected the disenrollment rate of women with both the treatment (breast/cervical) and control cancers. We used a parametric hazard model with a Weibull distribution to analyze the odds of disenrollment. Results: The unadjusted disenrollment rate declined 50% for women with breast and cervical cancers, whereas it increased over 30% for those with control cancers, pre- versus post-BCCPTA. The direction and magnitude of these results held after adjusting for socio-demographics and area characteristics that could affect disenrollment rates. Conclusion: Georgia BCCPTA has the potential to improve continuity of care for women with breast and cervical cancers because they experience more stable coverage and simpler recertification process under this new eligibility category.