Medicaid Breast Cancer Coverage Denied Because Patient Is A Man

Breast cancer patient Raymond Johnson
Breast cancer patient Raymond Johnson

They're a tiny minority of the patients, but men do get breast cancer, too.

Medicaid doesn't seem to know that, though. Renee Dudley of the Post And Courier has just uncovered a Medicaid loophole so outrageous that even though the case she reports on is in South Carolina, it merits attention from coast to coast. In brief, an uninsured man was denied coverage by a Medicaid breast cancer program because he's not a woman. As one of the commenters on the piece said, "What happened to good ole common sense?"

The full report is here at It begins:

Raymond Johnson checked himself into the emergency room last month for a throbbing pain in his chest.

The 26-year-old was stunned when the doctors delivered his diagnosis — breast cancer.

Uninsured and unable to pay for costly surgery and chemotherapy, the Cross resident followed the advice of his patient advocate and applied for a Medicaid program that covers breast cancer treatment.

Raymond Johnson of Cross found a lump in his left breast and was diagnosed with breast cancer in July. Uninsured, Johnson, 26, must rely on the generosity of hospitals and doctors for treatment.
A few days later, Johnson got another surprise. He was denied for the program because he is a man.

The Breast and Cervical Cancer Prevention and Treatment Act, a federal law enacted in 2000, uses Medicaid funds to cover treatment for breast cancer or cervical cancer patients who otherwise wouldn't qualify for the state and federally funded health insurance program for the poor and disabled.

Patients must meet a host of eligibility requirements. According to the South Carolina Medicaid agency, Johnson met all except one: Men aren't allowed.

This program aired on August 8, 2011. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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