Women with breast or cervical cancer who qualify for a certain Medicaid program can sign up the day of their diagnosis for the federal insurance that pays for their treatment — but only if they go to the right clinic.
If, by chance, they happen to get diagnosed at a site not designated for Women’s Wellness Connection, they are not eligible. And they are blocked from ever enrolling during their cancer treatment.
“A woman’s treatment shouldn’t depend on what door she walked into to get diagnosed,” said state Rep. Dianne Primavera, a Broomfield Democrat and breast cancer survivor.
Primavera and other advocates for cancer patients are pushing Colorado to change its rules, saying an estimated 250 women without health insurance are unfairly cut off from Women’s Wellness Connection each year.
Among them is Jeanette Oxelson, a Denver woman who was diagnosed with stage 3 breast cancer at Lutheran Medical Center in Wheat Ridge — which is not a designated screening site for the program.
Oxelson, who was uninsured when she felt a lump in her breast the diameter of a dime, spent two weeks trying to get a doctor’s appointment. Eventually, her husband’s diabetes doctor sent Oxelson to Lutheran for a mammogram. By then, the tumor had grown to the size of a golf ball.
And because her diagnosis came from Lutheran, it was too late for Oxelson to qualify for the government insurance that would have paid for her treatment. Even though she was otherwise eligible, Medicaid would not treat her cancer because of where she was screened. Her bills from Lutheran totaled nearly $6,000, and one was turned over to a collection agency because she didn’t pay on time.
The rest of Oxelson’s treatment since November 2008 — surgery, chemotherapy, radiation — was covered through a grant set up by the Denver affiliate of Susan G. Komen for the Cure. Now she is cancer-free. Oxelson wonders, though, whether some women die because they can’t afford treatment.
Without help from Komen, Oxelson says she would have gone bankrupt.
“They would have taken my house and I’d be living under a bridge,” the 64-year-old said.
Women’s Wellness Connection, created in 2000, was intended to help cancer patients with incomes slightly higher than those who qualify for Medicaid but who do not have insurance. It allows states to provide full Medicaid coverage to women who otherwise wouldn’t have any.
Additional $25 fee
A law passed by the state legislature last year added a $25 fee to Colorado’s breast cancer license plate, with the money going toward expanding eligibility in Women’s Wellness Connection.
The federal government lets states decide eligibility, and Colorado, for budget reasons, used the strictest requirements — only women diagnosed using program dollars get their treatment covered for the duration of their disease.
That means women in Colorado must get diagnosed at one of about 125 designated sites across the state to enroll in the program. Women who get mammograms or cervical cancer screening at many private imaging centers are not eligible, no matter how needy they are.
Average cancer treatment through the program is estimated to cost about $30,000 per patient — about two-thirds from the federal government and one-third from the state.
When the new license plate fee generates enough money to pay for an additional 300 patients — about $9 million — the state Department of Health Care Policy and Financing will expand eligibility, said department spokeswoman Joanne Lindsay.
So far, the state has collected $84,000. The amount generated monthly varies widely so state officials “have no idea when we will hit the mark required to make policy changes,” Lindsay said.
The program now has 437 patients.
Greater eligibility
Pushing for greater eligibility in the Women’s Wellness program is among the ways Komen for the Cure leaders hope to improve access to treatment in Colorado. They also are supporting a bill now up for debate at the Capitol that would require insurance companies to cover mammograms for women at risk of developing breast cancer, no matter their age.
Primavera, who is sponsoring the legislation, was diagnosed at age 38. Her daughters should begin having mammograms at age 30, she said. Her legislation arose out of fear that insurance companies might scale back coverage after a government task force’s suggestion last fall that women don’t need mammograms until they are 50.
Komen officials wish the bill would go further — requiring mammography coverage for any woman over 40.
“We do a good job saying, ‘Go out and get your mammograms,’ but then people pick up the phone and their insurance won’t cover it,” said Jill Fricker, director of mission initiatives for Komen in Denver.
The Komen mission is particularly important in Colorado, where one in seven women develop breast cancer — higher than the national average of one in eight.
Uninsured cancer patients are 60 percent more likely to die from the disease within five years, compared with people with insurance, Fricker said.
“Who lives and who dies depends largely on access to health insurance,” she said.
Jennifer Brown: 303-954-1593 or jenbrown@denverpost.com
Breast cancer in Colorado
35.6
Percentage of women age 40 or older who haven’t had a mammogram in the past year
38.6
Percentage of women in Denver who haven’t had a mammogram in the past year, among the highest in the state
57.9
Average age of a woman with breast cancer, slightly younger than the national average of 59.1
2
Percentage by which the overall breast cancer death rate has declined each year since 1990
538
Women who died of breast cancer in 2007
