Man With Breast Cancer Denied Medicaid Coverage Because He's Not Female

By Anna North | August 8, 2011 | 1:40pm

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A breast cancer patient applied for coverage under a federal program to treat the disease, but was rejected. The reason: he’s a man.

According to the Post & Courier, Raymond Johnson was diagnosed in July, and applied for coverage under the federal Breast and Cervical Cancer Prevention and Treatment Act. The Centers for Medicare & Medicaid Services, which administers the coverage, rejected him because patients have to be diagnosed via specific early detection programs — and those programs are only open to women. Johnson is angry, saying, “Cancer doesn’t discriminate, so this program shouldn’t discriminate.” And the South Carolina Dept. of Health and Human Services is behind him, asking the CMS to reverse its decision. Meanwhile, Johnson, who is uninsured, has to rely on a patchwork of nonprofit aid and on help from healthcare providers in order to get his chemo.

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The issue of screening isn’t a simple one. A little over 2,000 men get breast cancer every year in the US, but that number is low enough that regular screening isn’t recommended. It’s not that surprising that a special early detection program doesn’t cover this low-risk group (it also doesn’t cover women under 47 or over 64). The CMS could argue that it’s just treating men the same way it treats women who get breast cancer at very young or very advanced ages — these are just groups that fall outside the purview of the Breast and Cervical Cancer Prevention and Treatment Act. But if that means these groups aren’t able to get the care they need, that’s a problem.

The real solution to this, of course, would be affordable universal health care, but until that happens, the CMS does need to recognize that its guidelines disadvantage some cancer patients. This doesn’t mean that all men should be screened — although some gene mutations appear to increase the risk of male breast cancer, and perhaps in future men could undergo testing for these. Rather, it means that the CMS needs to figure out a way to fill the gaps in its coverage so that all patients in need have equal access to treatment.

Treatment DENIED: Cross Resident With Breast Cancer Disqualified For Medicaid Program Because He Is A Man [Post & Courier]

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