Budget cuts, poor fiscal management threaten breast cancer screening for needy women

Susan G. Komen for the Cure® Los Angeles County AffiliateJun 11 2010

The California State Auditor released an audit today of California's Every Woman Counts (EWC) program that suggests the state's ability to adequately provide breast cancer screening for its neediest women is threatened by budget cuts and poor fiscal management, according to the seven California Affiliates of Susan G. Komen for the Cure®, the global leader of the breast cancer movement.

“What we now know is that in addition to more funding, Every Woman Counts needs significant internal reforms to ensure that funds are being used properly - to help save the lives of women in need.”

"We've known that many women in our state were not receiving the breast cancer screening that they need because of California's budget crisis," said Deb Weintraub, Mission Director of the Los Angeles County Affiliate of Susan G. Komen for the Cure®. "What we now know is that in addition to more funding, Every Woman Counts needs significant internal reforms to ensure that funds are being used properly - to help save the lives of women in need."

Late last year the California Department of Public Health (CDPH) suspended all new enrollments for breast cancer screening services under EWC, effective January 1, 2010 until July 2, 2010. CDPH also raised the eligibility age for breast cancer screening services to 50 years of age and over indefinitely. The state blamed the reduction in services on declining tobacco tax revenues and increasing caseloads, which were causing the demand for services to exceed available funding. At the time, California's seven Komen for the Cure Affiliates, which collaborate on state-wide public policy issues, called for the suspension to be lifted and the eligibility age to be restored to age 40 and above. In addition, they supported Assembly members Noreen Evans and Pedro Nava in their call for an independent audit of EWC.

Detecting breast cancer early significantly increases one's chances of surviving the disease. Komen Affiliates want to ensure that all women age 40 and older have access to lifesaving breast cancer screening and early detection. The CDPH, in conjunction with the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program, funds breast cancer screening to low-income uninsured and underinsured women who are not eligible for Medicaid.

The State Audit found that:

• Declining revenue and budget cuts severely impede the program's ability to serve all eligible California women.
• CDPH failed to maximize the funding it does receive to provide breast cancer screening services, possibly resulting in tens of thousands of women not receiving services for which they were eligible.
• CDPH cannot provide an accounting of exactly how much of EWC funding their own contractors spent on services other than screening.
• The CDPH needs improvements in transparency and accountability and has not complied with some state laws, including a requirement that they provide a report on the EWC program annually to the legislature and develop regulations on how the EWC program will be implemented.

These findings come on the heels of an internal audit conducted by CDPH and released on May 25, 2010 that found internal management and governance over the EWC Program is fragmented and decentralized, severely impairing CDPH's ability to administer and make mission-critical changes needed to deliver life-saving screening for underserved women in California. In addition, the internal audit found that:

• CDPH over-reported more than 130,000 cases.
• There were 4,350 duplicate beneficiaries within the current claims system. Based on the duplicate beneficiaries, the Program has been assessed $218,000 in duplicate billings.
• EWC pays Case Management Service (CMS) fees to primary care providers, a practice that four out of five states in the national program do not pay. In fiscal year 2008-09, CMS fees represented $8.98 million, or 17 percent of total EWC Program funding.
• $15.3 million in cash from July 2007 had not been recorded in accounting records as of June 30, 2009.

"We fully understand that tobacco tax revenues are declining, which has contributed to declining funds for the program," said Weintraub. "If that trend continues, it may impact the sustainability of the program unless other sources of funds are developed. Yet the program's sustainability is also threatened by lack of internal controls. It is critical that management and governance reforms be made to ensure that funds are being spent directly on patients in need."

Komen noted that when breast cancer is detected early, before it spreads beyond the breast, the 5-year relative survival rate is 98 percent. Once the cancer spreads to other parts of the body, survival rates plummet to 23 percent.

"We do not envy the difficult decisions our elected leaders must make as the budget is finalized for the next fiscal year," said Weintraub. "However, the patients, survivors and advocates in our network implore California's leaders to remember the women who, without life-saving breast cancer screening and treatment services offered through the EWC Program, will have nowhere else to go."