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STATE | ASPS Calls on Utah to Maintain Medicaid Coverage for Breast Cancer Reconstruction

In the beginning of September, the Utah Department of Health proposed a rule to amend the state's Medicaid policy for reconstructive and cosmetic procedures. This amendment sought to limit coverage for reconstructive surgeries to initial occurrences and proposed that Utah Medicaid not cover repeat procedures. Currently, Utah's Medicaid Policy for Reconstructive and Cosmetic Procedures lists reconstructive or restorative services as medically necessary and performed on abnormal structures of the body to improve and restore bodily function or to correct deformity resulting from disease, trauma, congenital anomaly, or previous therapeutic intervention. The department's proposal also removes "or therapeutic intervention" from the list, thus further restricting Medicaid enrollees' access to critical reconstructive care.

As the amended regulation was in direct conflict with the Society's mission, comments were submitted urging the department to maintain Medicaid coverage for breast reconstruction surgeries for women in need. Additionally, the introduction of this proposal brought forth many questions of how Utah would implement the new rule. For example, the FDA recommends replacement of broken implants. However, if Utah were to limit breast reconstruction coverage to initial occurrences, it is unclear whether the state would ignore FDA guidelines by not covering replacement.

Given the fact that the Breast Cancer Patient Education Act (BCPEA) was signed into law less than two years ago, it is worrisome to witness states work to decrease access and awareness surrounding reconstructive options. ASPS does not believe that cutting costs at the expense of vulnerable populations is the answer to any problem and further state action seeking to diminish the efforts of the BCPEA or Women's Health and Cancer Rights Act of 1998 will be monitored and responded to accordingly.

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