Health services for women increased in state budget

Actions by the Ohio Legislature, coupled with cooperative efforts from the office of Gov. Mike DeWine, will substantially increase the scope of services for an underserved population of women seeking breast and cervical cancer diagnostic services.

Julie McMahon, mission director for the Ohio branch of the Susan G. Komen foundation, said that Ohio lawmakers in the biennial budget passed last month had increased funding for the Breast and Cervical Cancer Project by $350,000 and increased the range of ages and income levels for women eligible for the service.

“We were looking for three things from the legislature in this budget – increased funding, expanded eligibility and a change to the way special Medicaid is accessed,” she said.

The program got the additional money and the expanded eligibility but not the change of accessibility. The latter, however, can be done administratively, she said, with help from the governor’s office.

The extra $350,000 for the program will be magnified to more than $1 million by a three-to-one matching grant from the Centers for Disease Control and Prevention, she said.

The project helps women who don’t qualify for Medicaid but also don’t have the means to get diagnostic services such as mammograms.

According to Ohio Department of Health data, the program provided diagnostic services to more than 97,000 women from March 1994 to April 2017, of whom 417 were in Washington County. Statewide, 3,311 cases of breast cancer and 2,214 case of cervical cancer were diagnosed.

The state data does not include county-level cases diagnosed.

“Southeastern Ohio underutilizes this program,” McMahon said. “We try to find people and refer them.”

In Southeastern Ohio, the program is administered through Ohio University, which McMahon said has traveling outreach with a nurse practitioner.

“They offer well-woman tests and screenings, they come to Marietta and Belpre,” she said.

The expanded eligibility for the program means it now includes services for women as young as 21 and over 65 – it was previously limited to women between 25 and 64. The legislature also raised the income level for eligibility from 250 percent of the federal poverty level to 300 percent.

Another obstacle for the program has been access to treatment, McMahon said. The treatment expenses can be covered under a special provision of Medicaid for women who would not normally qualify, but they have to be referred through the BCCP diagnostic program. Those who pay cash or use private or employer insurance for diagnostics, for example, can’t receive the Medicaid support for treatment, a phenomenon McMahon calls “the wrong door problem.”

“For example, a woman with employer-based health insurance is diagnosed with metastatic breast cancer, and can no longer work through treatment, finding herself uninsured and with no income,” a memo from the Komen foundation said. “Currently, she is locked out of BCCP Medicaid for treatment. Or a woman may not know about BCCP … She is screened, diagnosed with breast cancer, and because BCCP didn’t pay for those tests, she is locked out of BCCP Medicaid for treatment.”

McMahon said that although the legislature did not pass an amendment to change the special Medicaid treatment requirements, the foundation is working with the governor’s office to have the changes made through the administrative system.

The program is not widely known, but awareness is improving, McMahon said.

In Washington County, for example, women who accessed diagnostic services went from 21 in 2016-17 to 37 in 2018-19, an increase of 70 percent.

With the added funding this year from the state, McMahon said, she hopes the program will be able to reach another 2,000 women.

Carole Merkle at the Ohio University Heritage College of Osteopathic Medicine is the southeast Ohio coordinator for the program.

“We have a clinical arm through the medical center here and through mobile outreach programs. We schedule patients for pap smears, pelvic exams, mammograms and provide full service in conjunction with our partners,” she said. “We’re also the fiscal agent, in that we hold the resources – the money – for hospital systems.”

Merkle said women can be referred to the program through providers such as the Memorial Health System, with whom the program is in regular contact. Practitioners such as OB-GYN doctors and surgeons also provide referrals.

“We have quarterly meetings with the hospitals,” she said. The southeast Ohio branch of the women’s health program covers 17 counties, and the program has frequent outreach events using its mobile clinic.

“We don’t do mammograms, but we park right at the hospital and offer them on a same-day basis, to decrease missed opportunities,” Merkle said.

The women served by the program most often are either uninsured or underinsured and working, she said. They often are reluctant to take time off from work – or can’t get the time – so the program has built in convenience and flexibility of access. The mobile clinic goes to workplaces, and Merkle said employers have been cooperative.

“Employers are really great about letting workers come out and get screened,” she said. “They realize it’s a lot better to have healthy employees. We see a lot of women who don’t get sick days, and we’ve had women who knew something was wrong but can’t afford to miss work.”

She said a dozen workplaces were on the mobile clinic schedule this year, five of which were new.

The Ohio University-based outreach program will come to Belpre on Sept. 25 at the Memorial campus, and to Marietta on Oct. 22 at the Marietta College Physicians Assistant program building.

“A lot of people are pleasantly surprised at how nice our mobile clinic is. We have a lobby, private exam rooms, restrooms, and it’s wheelchair accessible,” Merkle said.

For information on the outreach program, contact the coordinator at Ohio University by calling 740-593-2432.

Ohio Breast and Cervical Cancer Project

• Legislature added $350,000 of additional funding per year for two years.

• Expanded eligibility, lowering age from 25 to 21, and adding income levels up to 300 percent of the federal poverty level, up from 250 percent.

• Program funds critical women’s health screening and diagnostic services for low-income, uninsured and underinsured women who do not qualify for Medicaid.

Source: Breast and Cervical Cancer Project.