Wednesday, August 24, 2011

After uproar, man with breast cancer OK’d for coverage

In Georgia, single people w/o children who are not on disability are not eligible for Medicaid if they make more than $235 per month ($2,820 per year).

By Joan Raymond contributor
updated 8/22/2011 3:31:07 PM ET

Raymond Johnson was due for some good news.

Earlier this month, reported that because he’s a man , Johnson, 26, of South Carolina, was denied Medicaid coverage after being diagnosed with breast cancer.

But late last week, Johnson got the call he was waiting for: South Carolina’s Department of Health and Human Services is granting him coverage, after all.

Johnson, a tile layer who worked about 30 hours a week making $9 per hour, could not afford private insurance. He discovered he had Stage II breast cancer after visiting a local emergency room for chest pain.

Although he was not eligible for traditional Medicaid coverage, Johnson was told to apply for coverage under Medicaid’s Breast and Cervical Cancer Prevention and Treatment Act, an 11-year-old federal mandate designed to help people who may not fit into traditional Medicaid eligibility requirements. But the program only provides care for women.

Read on: Breast cancer patient denied coverage since he's a man

In a statement to the press, South Carolina Health and Human Services Director Tony Keck, announced that after speaking with the federal Centers for Medicare & Medicaid Services, “. . . we believe it is in the best interest of Mr. Johnson to deem him eligible for the Medicaid Breast and Cervical Cancer Program.”
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The state health department will submit claims to the federal government for reimbursement. So far, though, state officials have gotten mixed messages on Raymond’s case from their contacts at Medicaid.

“If federal lawyers choose to deny those claims based on a discriminatory policy, that is their choice and our department will appeal the decision,” Keck says.

The national media attention Johnson’s plight has received has raised the profile not only of male breast cancer, but has also raised awareness of what it means to be Medicaid eligible.

“There is a misperception that Medicaid is for all poor people, when you actually have to fit into a very specific category, much of which is determined at the state level,” explained Jeff Stensland, a health department spokesperson. For example, if Johnson was diagnosed with, say, colorectal cancer or a brain tumor, he still wouldn’t get coverage under Medicaid. South Carolina, like most states, does not provide Medicaid to single, childless adults.



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