Coverage denial by state illegal

The state of Idaho illegally denied Medicaid insurance coverage for women with breast cancer, according to a recent ruling by District Judge John P. Luster.

The case involved Coeur d’Alene resident Burnice Hauser, who was diagnosed with breast cancer three years ago.

Hauser underwent surgery to remove the cancer and was later placed on a drug therapy program to minimize the risk of the cancer returning, according to court documents.

In June 2002, the Idaho Department of Health and Welfare tightened the eligibility of Medicaid coverage for cancer treatment and notified Hauser that her cancer therapy would no longer be covered by the state.

“Idaho was trying to artificially restrict the federal law,” said Hauser’s attorney, Alan Wasserman, with Idaho Legal Aid Services.

Judge Luster agreed and ruled that the state acted illegally in using a temporary rule to restrict Medicaid coverage.

Even after the rule became permanent, it violated federal law that provides Medicaid for women receiving cancer treatment, Wasserman said.

In 2000, Congress adopted the Breast and Cervical Cancer Prevention and Treatment Act to allow each state’s Medicaid program to offer coverage to women with breast and cervical cancer. Idaho then agreed to provide the coverage “for the duration of her cancer treatment,” according to state law.

Hauser began a multiyear drug therapy regimen shortly before the state narrowed its cancer benefit, according to court documents.

At the time, Hauser showed no evidence of breast cancer, but the Femara drug therapy was prescribed by her doctor to reduce the risk of the cancer returning.