Many states mandate that private insurance companies, Medicaid, and public employee health plans provide coverage and reimbursement for specific health services and procedures. The ACS supports these initiatives when it comes to cancer prevention, early detection, and treatment services. This overview provides a snapshot of state mandated coverage for private heath plans, Medicaid, and Medicare coverage of early detection services for cervical cancer screening.

CERVICAL CANCER EARLY DETECTION

The American Cancer Society's current early detection guidelines recommend that all women who are or have been sexually active or who are 18 and older should have an annual Pap test and pelvic examination. After three or more consecutive satisfactory examinations with normal findings, the Pap test may be performed less frequently. The Society believes that the frequency of pap smears following a baseline of three normal Paps in row should be determined by the women and her health care provider. Regular cervical cancer testing is the best way to prevent unnecessary deaths due to cervical cancer.

State Mandates for Private Health Insurance

Twenty-three states require private health insurers to cover cervical cancer early detection testing. Illinois and Ohio have mandates that public employee health benefit plans cover cervical cancer testing, and Maryland has a unique law requiring hospitals to offer a Pap test to adult female inpatients.

Self-Insured Plans

ERISA, or self-insured plans, are not regulated at the state level and therefore women in these plans do not necessarily get cervical cancer early detection benefits, even if there are mandates in the states to cover such benefits. Self-insured plans are typically large employers. Women who have self-insured based health insurance should check with their health plans to see what cervical cancer early detection services are offered.

Medicaid

By statute or agency policy, Medicaid or public assistance programs in all 50 states and the District of Columbia cover testing for cervical cancer either routinely or upon physician's recommendation. This coverage may or may not conform to American Cancer Society guidelines. Please check with state Medicaid offices to learn more about what services are provided for cervical cancer testing. A list of state Medicaid offices can be located on the internet at www.medicaid.aphsa.org/members.htm.

National Breast and Cervical Cancer Early Detection Program

Furthermore, all states are making breast cancer early detection testing more available to medically underserved women through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This program provides breast and cervical cancer testing to women without health insurance for free or at very little cost. The NBCCEDP attempts to reach as many women in medically underserved communities as possible, including older women, women without health insurance and women who are members of racial and ethnic minorities.

Though the program is administered within each state, the Center for Disease Control and Prevention (CDC) provide matching funds and support to each state program. Now in its tenth year, the program has provided 2 million early detection exams to underserved women, diagnosed over 5,800 breast cancers, over 31,000 precancerous cervical lesions, and over 500 cervical cancers. After a 10 year commitment, we are now beginning to detect new cancers at their earliest stages leading to longer term survival. These accomplishments demonstrate a truly nationwide effort. Unfortunately however due to limited resources, only 12-15% of all eligible women are served nationwide.

Offered mainly through non-profit organizations and local health clinics, this program is aimed at providing early detection testing for breast and cervical cancer in medically underserved women. Each state's Department of Health will have information on how to contact the nearest program participant. For more information on this program, please contact the CDC at 1-888-842-6355 or on the internet at www.cdc.gov/cancer.

Medicare

Medicare provides coverage for a pap smear, pelvic exam and a clinical breast exam every three years for Medicare beneficiaries. Furthermore, if a woman is considered high-risk, at childbearing age or has had an abnormal pap smear in the preceding three years, she would be eligible under Medicare to be covered for a pap smear every year.

States with Laws Mandating Coverage of Cervical Cancer Early Detection Testing
May, 2000

State	Private Insurance	Other
Alaska	Annual test for persons over age 18
California	Upon referral of patient's health care provider Annually	Medicare supplemental: cover costs exceeding Medicare Coverage limits; annual test
Delaware	Specified coverage
District of Columbia	Annual testing as medically necessary
Georgia	Annual or more often with physician order
Illinois	Annual test	State employees, county and education employee: annual test
Kansas	Pap test covered if "lab services" are covered under existing plan
Louisiana	Annual test
Maine	Annual test
Maryland		hospitals: offer to adult female inpatients
Minnesota	Cover routine testing	extended basic Medicare supplement plan must cover 100% of cost
Missouri	Cover testing for non-symptomatic women
Nebraska		Outreach and provisions for screening of Native American population
New Jersey	20 or older, every two years or more frequently with doctor referral
New York	Annual, 18 and older
Nevada	Annual, 18 and older
New Mexico	Coverage
North Carolina	Annual	Public employee plan
Ohio	Specified coverage	Public employee plan: specified coverage
Oregon	18-64, annual. More often with doctor referral
Pennsylvania	Annual
Rhode Island	Requires all insurers to cover Pap tests in accordance with ACS guidelines
South Carolina	Annual
Virginia	Annual test
West Virginia	Annual, more frequent with doctor referral

Revised: 10/18/2000