Cancer Services for Medicaid Patients in District of Columbia

Arlington, Virginia—To address oncology services issues in communities involving Medicaid and other low-income patients, stakeholders must work together to identify problems and offer solutions, according to healthcare professionals at the Medicaid Managed Care Summit. The speakers were Mandi Pratt Chapman, MA, director, Division of Cancer Survivorship at George Washington University’s Cancer Institute, and Jennifer Dziedzic Leonard, JD, MPH, associate professor in George Washington University’s School of Public Health and Health Services. Their presentation was titled Delivery and Coordination of Cancer Services to Medicaid and Alliance Patients in the District of Columbia. Ms. Chapman and Ms. Leonard worked with the District of Columbia’s Department of Health Care Finance and Department of Health to improve access to timely and quality cancer treatments for the District of Columbia’s Medicaid and HealthCare Alliance patients. The HealthCare Alliance is intended for residents who are not eligible for federally financed Medicaid benefits, including non-disabled childless adults and some people whose income is too high to be eligible for Medicaid. According to the speakers, of the 550,000 people who live in the District of Columbia, 58% are black and 10% are Hispanic. They also indicated that the District of Columbia’s cancer mortality rate is among the highest in the United States. The mortality rate for black residents is higher than the US average, whereas the mortality rate for white residents is lower than the US average. The speakers said that cancer patients covered by Medicaid or the HealthCare Alliance do not receive adequate treatment, while providers are frustrated with reimbursement rates and administrative burdens associated with serving managed care patients. For instance, primary care physicians and managed care organization case managers have trouble finding oncology specialists to treat patients. Adding to the burden, the Department of Health Care Finance also must negotiate access to cancer treatments on a case-by-case basis, according to the presenters. To help identify the issues, a group was convened that included representatives from George Washington University’s Cancer Institute for the Advancement of Cancer Survivorship, Navigation, and Policy; DC Cancer Consortium; DC Department of Health Care Finance; DC Department of Health; and a private outpatient provider. As part of their research, they reviewed literature, created case scenarios identifying obstacles for quality cancer care to Medicaid and HealthCare Alliance patients, and developed financial models that showed a gap between the cost of care and reimbursement rates to providers. Among the problems that the group identified were that drug reimbursement rates do not cover the drug costs, an insufficient and inaccessible provider network, no coverage for a biopsy, and a lack of care management. The recommendations presented to help improve care for Medicaid and HealthCare Alliance patients included increasing drug reimbursements, mandating that managed care contracts have an adequate provider network, providing funding for screening and biopsies, eliminating retroactive clawbacks, and eliminating transitions between managed care and fee-for-service systems. After identifying the issues, the group created a white paper that will soon be presented to leaders in the District of Columbia, according to the presenters. They said the group would highlight providers’ efforts to solve access-to-care problems.