Three years ago, Stephen Cadmus faced a dilemma. He needed to see a doctor, but he had no health insurance.
Cadmus was financially wiped out five years earlier when the tech consulting business he owned fell victim to the Stanford Financial Group’s $7 billion Ponzi scheme. Some 28,000 investors bought certificates of deposit from Stanford International Bank in Antigua, which was owned by Houston financier R. Allen Stanford. But most of the clients’ money financed Stanford’s lavish lifestyle instead of the securities it was supposed to.
“My company had been buying investments from Stanford for more than five years,” Cadmus says. “We lost it all — every last penny.”
To get the medical attention he needed but couldn’t afford, Cadmus visited a local clinic that offered reduced-fee services. He shared his concerns about seeing blood in his stool, and doctors gave him a take-home test called FIT, or fecal immunochemical test. Test takers swab a small amount of stool on a stick, place the stick in a plastic container and mail it to a lab for analysis.
Within days, the results of Cadmus’ test showed blood in his stool — a possible indicator of colorectal cancer — so he underwent a colonoscopy. Results showed he had stage II colorectal cancer.
“I had absolutely no other symptoms that would have led me to believe anything was wrong,” he says. “My worst fears were realized.”
Cadmus’ FIT test and colonoscopy were provided free through the FIT-Flu program. Designed by colorectal cancer experts at the University of California, San Francisco, the program offers free FIT tests, along with annual flu shots, to low-income, uninsured, Medicaid-eligible adults ages 50 to 75. FIT-Flu is underway at various sites throughout the country, including MD Anderson. The American Cancer Society recommends the program and helps clinics implement it.
“Without this program, my cancer would not have been discovered,” Cadmus says. “On so many levels, I am very fortunate.”
Since 2013, MD Anderson has partnered with federally qualified health centers in nine Texas counties to provide cancer screening and prevention services, including FIT-Flu. These centers receive enhanced reimbursement from the Centers for Medicare and Medicaid Services (CMS) in exchange for providing care to those covered by Medicaid, the joint federal and state program that helps those with limited income and resources get medical care.
“MD Anderson’s programs have leveled the playing field by allowing us to provide our patients with screenings they couldn’t easily get,” says Kavon Young, M.D., medical director of El Centro de Corazon, a partner clinic in Houston’s historic East End that primarily serves uninsured Hispanic patients.
According to the Texas Medical Association, more than 5 million Texans are without health insurance.
“There’s been a need for cancer control efforts for the low-income and uninsured in our community for a long time that we’ve been unable to address because of lack of funding,” says Lewis Foxhall, M.D., vice president for MD Anderson’s Office of Health Policy, which spearheads the cancer center’s initiatives for the underserved.
But thanks to funding from the CMS, Foxhall says MD Anderson can now offer many vital programs to this population, including mobile mammography, skin and colorectal cancer screenings, tobacco prevention and cessation, and childhood obesity prevention.
More than 400 people have received skin screenings and more than 4,500 have had mammograms. Of the 7,500 who’ve received the take-home FIT test, 300 have received follow-up colonoscopies, 110 had precancerous polyps removed to prevent cancer from developing, and 21 have been diagnosed with cancer and referred for further care.
These programs are made possible in part by funding from the Medicaid 1115 Transformation Waiver, which allows Texas to expand Medicaid managed care and funding to hospitals and clinics that serve large numbers of uninsured patients. A grant from the Cancer Prevention and Research Institute of Texas also helps pay for the programs and recently expanded FIT-Flu to an additional 19 counties. While screening and diagnostic procedures are funded, treatment is not. However, patients who need additional follow-up are connected with program navigators who steer them to treatment they can afford.
“It’s very refreshing as a provider to talk with patients about the next steps, and to reassure them that MD Anderson is going to take that next step with them,” Young says.
Despite their successes, these programs face an uncertain future. The Medicaid 1115 Transformation Waiver has been extended through 2017, but ongoing discussions between Texas and CMS will determine the status of future funding.
Although the support of CMS may not be constant, MD Anderson intends to find a way to continue providing these services, says Foxhall.
“It’s been very exciting to see the reception in the primary care community to these programs,” he says. “Our partner clinics have really taken advantage of these potentially lifesaving interventions, and we are very appreciative of all the work that they’re doing with us to help address these needs.”
Cadmus, whose company has recovered from its losses and is doing well, also appreciates the partnerships.
“I know how very lucky I am. The doctor, the clinic and the MD Anderson screening program literally saved my life.”