title: The Breast and Cervical Cancer Prevention and Treatment Act in Georgia: effects on time to Medicaid enrollment.
abstract: BACKGROUND
  Implementation of the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) allowed states to extend Medicaid to any woman aged <65 without insurance screened and found to need treatment either for breast or cervical cancer or for a precancerous cervical condition through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) or in Georgia, other provider sites.
  
  
  METHODS
  The authors used linked Georgia Comprehensive Cancer Registry (GCCR) and Medicaid data to test the: 1) likelihood of Medicaid enrollment in a given month and 2) time-to-enrollment (months) for those eventually enrolling. The authors used difference-in-differences analysis to estimate the effects of BCCPTA for breast or cervical cancer cases relative to a control group of women with other cancers. The authors controlled for sociodemographics, stage at diagnosis, year of diagnosis, and county level factors related to insurance levels in the area.
  
  
  RESULTS
  Compared with the control cancer group, the hazard ratio of Medicaid enrollment for women with breast and cervical cancers increased post- vs pre-BCCPTA implementation. The estimated effect of this increase was that out of every 1000 women with breast cancer, BCCPTA led to 1.7 more (from 2.8 to 4.5 per month) enrolling in Medicaid. The results for women with local or later stages of cervical cancer indicated that of 1000 women with these cancers, the number enrolling in a given month increased by 3.4 due to BCCPTA. Results on time-to-enrollment indicated that the time between cancer diagnosis and enrollment was shortened by 7 to 8 months.
  
  
  CONCLUSIONS
  The Georgia Medicaid program, in response to national legislation, increased the probability of women enrolling in Medicaid earlier and in turn, likely increased their cancer treatment options.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. eadam01@sph.emory.edu
authors.forename: E Kathleen
authors.initials: EK
authors.lastname: Adams
authors.forename: Li-Nien
authors.initials: LN
authors.lastname: Chien
authors.forename: Curtis S
authors.initials: CS
authors.lastname: Florence
authors.forename: Cheryl
authors.initials: C
authors.lastname: Raskind-Hood
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D005845:Georgia; D006078:Government Programs / Q000331:legislation & jurisprudence*; D006801:Humans; D007883:Legislation, Medical; D008484:Medicaid; D008875:Middle Aged; D013997:Time Factors; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000628:therapy