Learn about the real life impact of prior authorization from two cancer patients who have dealt with this issue firsthand.
Medicaid Guidance Likely to Hurt Patients; Increase Number of Uninsured
Caps on Medicaid Could Significantly Reduce Access to Care
January 30, 2020
Washington, D.C., —Today the Centers for Medicare and Medicaid Services (CMS) announced guidance that would fundamentally alter the Medicaid program. The guidance would allow states to shift how they receive federal funding from a percentage match, wherein the program’s funding adjusts automatically to account for the number of enrollees and rising health care costs, to one where funding could be capped. These grants would apply specifically to the Medicaid expansion population and optional adult populations. The change in funding structure has the potential to significantly reduce low-income cancer patients, survivors and their families’ access to affordable, comprehensive health care in states that choose to apply.
Medicaid is the primary health insurance for nearly 65 million people, 2 million of whom have a history of cancer and an estimated 500,000 who gained coverage through expansion.
A statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN) follows:
“If allowed to take effect, today’s guidance would fundamentally alter the Medicaid program for those who’ve gained much-needed coverage through the program’s expansion. Allowing states to change their funding formula from one that accounts for enrollment shifts and medical cost increases within this population to one that is comprised of a single lump sum grant has the potential to significantly undermine the nation’s health insurance program for low-income Americans, likely leaving millions of people uninsured and unable to access the care they need.
“The limited funding that is inherent in an aggregate or per-capita cap could force states to implement enrollment freezes or waiting lists, deny certain medical benefits and services or increase cost-sharing for enrollees. For people with serious illnesses like cancer, these changes could reduce access to the care they need to manage their disease and put new treatments out of reach.
“Additionally, cancer patients may find it especially challenging to get the prescriptions they need as this guidance allows states to severely restrict prescription drug coverage. Cancer is more than 200 different diseases and limiting prescription coverage could deny enrollees access to the physician recommended medicine for their specific cancer.
“It could also leave people unable to access critical preventive and early detection services which could mean a later-stage diagnosis when treatment costs are higher, and survival is less likely. These changes are unlikely to reduce costs, but instead shift costs onto providers and health systems through uncompensated care and onto vulnerable patients who are among the least able to afford it.
“Considering that more than two million cancer patients and survivors rely on Medicaid for their health care coverage, allowing states to drastically alter how this program is funded puts their access to health care at risk.
“We strongly urge the administration to reverse course and maintain consistent and adequate funding for Medicaid as an essential high-quality health care program for so many of the country’s cancer patients, survivors and all those at risk for the disease.”
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