The University of Texas MD Anderson Cancer Center has a long tradition of providing care for low-income residents of Texas.
A financial assistance program provides coverage for care delivered at
MD Anderson to cancer patients who meet residency and financial eligibility requirements. Additionally, the institution participates in the Texas Medicaid program that provides state and federal support for certain low-income persons.
The care MD Anderson provides to these patients is referred to as uncompensated care.
How is uncompensated care defined and how much does MD Anderson provide?
In 2010, at the direction of the Texas Legislature, a new way for Texas hospitals to report total uncompensated care from all sources was adopted by the Texas Health and Human Services Commission. The formula is designed to provide a realistic picture of the impact on hospitals of providing care for which they are incurring unreimbursed costs.
Uncompensated care in Texas includes estimated unreimbursed costs for the uninsured (patients with no source of third-party insurance who qualify for direct financial assistance provided by MD Anderson) and the underinsured (those with insurance who, after contractual adjustment and third-party payments, have a responsibility to pay for an amount but are unable to pay). Uncompensated care also includes unreimbursed costs from government-sponsored health programs such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP), county indigent programs and other state or locally sponsored programs.
Using the State of Texas definition, MD Anderson provided an estimated $215 million in uncompensated care for more than 47,500 patients with cancer in Fiscal Year 2011 (Sept. 1, 2010-Aug. 31, 2011).
How does MD Anderson serve the low-income population?
MD Anderson has a long tradition of providing quality cancer care for many low-income residents of Texas.
In FY11, MD Anderson provided care to approximately 3,400 people who primarily had no third-party insurance and who qualified for partial or full financial assistance under MD Anderson’s patient financial assistance program. The estimated unreimbursed cost associated with these patients was $57.8 million.
In addition, MD Anderson provided care to approximately 3,800 people whose primary source of insurance coverage was a state or locally sponsored governmental program such as Medicaid, CHIP, Harris County Hospital District or other Texas county-specific indigent program. The estimated unreimbursed cost associated with these patients was $14.5 million.
MD Anderson’s combined estimated unreimbursed costs for these two categories of patients in FY11 was $72.3 million.
For the past 17 years, MD Anderson also has provided cancer services at Lyndon B. Johnson General Hospital for low-income Harris County residents. This program is staffed by MD Anderson faculty physicians, nurses and others at an annual cost to MD Anderson of $3.8 million. The MD Anderson program at LBJ General Hospital served 704 new patients and had 7,409 follow-up patient visits in FY11.
Who is eligible to receive MD Anderson financial assistance?
Eligibility requirements for financial assistance by MD Anderson include U.S. citizenship or designated legal status, Texas residency, low income and limited financial assets. Eligibility policies are established by MD Anderson and approved by The University of Texas System.
To learn more about eligibility for financial assistance from MD Anderson, review this Patient Financial Assistance flier.
How is uncompensated care funded?
Financial assistance provided by MD Anderson comes from state appropriations and funds generated by patient care activities.
How does MD Anderson help in Harris County?
To assist the large number of charity patients from Harris County who need cancer care, MD Anderson funds medical, urologic and gynecologic oncology services at LBJ General Hospital operated by the Harris County Hospital District (HCHD).
In FY11, 14 MD Anderson faculty physicians, 18 medical oncology physician fellows and a number of research nurses and mid-level providers staffed the oncology services at LBJ at a cost to MD Anderson of $3.8 million.
Some low-income patients from Harris County are not treated at LBJ and are referred to MD Anderson when they need highly specialized services or technologies. These patients include children and adolescents with cancer, adults with complex malignancies such as leukemia, pancreatic cancer and sarcomas, and candidates for blood and marrow transplantation. To learn more about
MD Anderson’s extensive program at LBJ, read this article.
Some HCHD patients who require radiation therapy also are treated at
MD Anderson under the patient financial assistance program.
What lies ahead?
An estimated 5.9 million Texans — 24% of the state’s population — are without health insurance, the highest percentage of uninsured citizens in the country.1 It is estimated that 17.9% of Texans have incomes below the federal poverty level.1
The population of Texas is expected to increase to 26 million in 2012 and to 36 million by 2040.2 Texans 65 or older likely will make up 18% of the state’s population by 2040,2 compared to 10.4% in 2010.3 The prevalence of cancer in Texas is predicted to soar dramatically during this period.4
The federal Patient Protection and Affordable Care Act of 2010 is expected to extend insurance coverage to more than 4 million Texans through private insurance and the expansion of Medicaid in the coming years.5 The additional coverage of millions of Texans will help address uncompensated care challenges for many working Texans through subsidized employer or individual coverage. However, much of the additional coverage for the lowest income people will be through expansion of the Medicaid program that currently does not fully fund the costs of cancer care in Texas.
Cancer care costs are still expected to grow significantly and a number of Texas residents will either choose not to purchase insurance or will not be eligible for coverage under the Affordable Care Act. Regardless of the ultimate direction of federal health programs, MD Anderson remains committed to providing care for low-income Texas residents.
1 U.S. Census Bureau, Small Area Income & Poverty Estimates (SAIPE), 2012.
2 Texas Data Center and Office of the State Demographer, 2012. Based on recommended migration scenarios for short- and long-term planning.
3 U.S. Census Bureau, 2010 Census, 2012.
4 American Cancer Society. "Cancer Facts & Figures 2012." Atlanta: American Cancer Society; 2012.
5 Texas Health and Human Services Commission, Texas Medicaid and CHIP in Perspective, Chapter 3. Federal Health Care Reform, January 2011.