Breast cancer patient denied Medicaid coverage … because of his gender

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Disease does not discriminate, but apparently Medicaid coverage does.

A 26-year-old South Carolina tile-layer has found himself with breast cancer and out of luck for one reason: He is a man. While breast cancer affects an estimated 2,000 American males annually, Medicaid does not cover treatment of the disease in men.

Raymond Johnson does not make enough money to afford the five-figure price of the treatment his cancer will require. Charleston Cancer Center patient advocate Susan Appelbaum is working to help Johnson navigate the difficult path to coverage.

“We’ve talked about an appeal, but the Medicaid office didn’t really seem to think it would change the law, by filing an appeal,” Appelbaum told TheDC. “Somehow we need to find a way to add an addendum to the law or change the law altogether to include men.”

The South Carolina Department of Health and Human Services said the discriminatory policy lies with the federal government.

“We are again urging CMS [the Centers for Medicare and Medicare Services] to reconsider,” the South Carolina Department of Health and Human Services said in a statement. “It’s a very clear example of how overly rigid federal regulations don’t serve the interests of the people we’re supposed to be helping.”

A CMS spokesperson told TheDC his agency aware of the policy and wants to find a way to rectify the problem.

“The law governing this specific program is linked to a CDC screening program,” CMS’s Brian Cook told TheDC, explaining that while the Breast and Cervical Cancer Prevention and Treatment Act of 2000 allows states to provide Medicaid benefits to the uninsured, the CDC’s screening system restricts men from receiving coverage.

“We are working with the CDC and South Carolina to see what options may exist to address this situation,” Cook added. “We are committed to ensuring that all individuals who should be eligible for this program have coverage.”

While Appelbaum and others work to help his situation, Appelbaum pointed out that time is of the essence, especially when it comes to cancer — and Johnson is facing a tumor the size of a baseball.

“There is nothing that’s going to happen quick enough for this man,” she said. “He needs chemotherapy to shrink his tumor and then he will be eligible for surgery and then after that he will have to go through radiation …. I’ve been told that ‘we’re working on it,’ I don’t now whether or not we’ll get anything accomplished before this gentleman — you know, he is going to have a multitude of bills and it is going to be financially overwhelming for him at his age, 26.”

Appelbaum and Johnson have reached out to South Carolina Republican Rep. Tim Scott for help.

“We are trying to see if this can be addressed administratively through CMS or if we have to go through the legislative rigmarole,” Scott’s press secretary Sean Smith told TheDC.

Scott’s district director has stepped in and is working with Appelbaum and Johnson to help appeal the decision.

“We definitely don’t agree with somebody being denied coverage simply because he is a man,” said Smith.

While the officials look into the glitch Johnson still is struggling with the disease and the financial repercussions. Private charities have come to his aid, including a group called Share Our Suzy, which has been sending him gas cards and helping him with utilities.

“He is going to incur a lot of bills. Financially, he will be devastated,” said Appelbaum. “He is such a great guy. If you only knew him.”

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Tags : medicaid
Caroline May