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History and Description of the Cancer Assistance Unit (formerly the Cancer Control Program)North Carolina has been at the forefront in
addressing the needs of its indigent residents with cancer. The Cancer Assistance Unit (CAU) was established by the General Assembly in 1945
under the Cancer Control Act of 1945 (General Statutes 130A-205) at the
urging of the Women's Field Army (now the American Cancer Society) and
the North Carolina Medical Society. The statute included the provision
that the Cancer Committee of the North Carolina Medical Society would
serve as an advisory council to the Department of Health and Human Services.
The legislative purpose was "to establish and administer a program
for the prevention and detection of cancer and for the care and treatment
of persons with cancer." This was the first such program in the nation.
Sixty-four percent of the Program's resources fund direct payments to physicians and hospitals by POMCS. In fiscal year 2000, 460 fee-for-service providers delivered CAU-sponsored diagnostic services to 1,507 North Carolina residents at an average cost of $573-of whom 93% were female; 34% were minority; and 73% had no third party coverage. In that same year, 299 providers delivered CAU-sponsored treatment services to 549 North Carolina residents -of whom 88% were female; 42 % were ages 21-34; 34% were minority; and 66% had some type of third party coverage. The average cost to the Program for treatment patients was $2,063. The breakdown by primary diagnosis was as follows: 19% breast, 59% cervical (includes pre-cancerous conditions), 3% colon, 1% lung, 2% prostate, 2% skin and 14% other. These numbers are unduplicated counts for providers and residents. It is important to note that the Program serves primarily those with little or no resources for cancer diagnostic and treatment services. Even though the Program income eligibility is set at 115% of poverty ($19,608 for a family of 4 for FY 2000), more than half of those served during FY 2000 were below 85% of the federal poverty level. Over the past two decades, the Program has instituted several policy changes that have affected eligibility. In FY 92, the medical eligibility was limited to the current 25% chance of five-year survival. In FY 95, the number of diagnostic and treatment service days was expanded from 2 and 8, to 8 and 30, respectively. The financial eligibility criterion also has varied over time, from 100% (net income) to 200% (gross income) of the federal poverty level for the brief period of July 1995 through March 1997. A major concern is that the current financial eligibility requirement of 115% of the federal poverty level (gross income), a response to the FY 97 budget shortfall, limits access for many cancer patients, particularly the working poor who lack insurance coverage. The low financial eligibility requirement, which considers gross income during the twelve months prior to the treatment request or application, and without any allowed deductions, essentially excludes previously working families that had no insurance coverage or lost it when they could not work during their treatment phase. For some, not qualifying for the Program may mean delaying or forgoing treatment services. Providers have up to one year from the date of service to submit an application to the Program for coverage. Usually the provider works with the local health department, hospital social worker or financial counselor to complete the required two-part application (financial eligibility form and service authorization request). Providers have up to one year from the date of service to submit an application to the Program for coverage. Usually the provider works with the local health department, hospital social worker or financial counselor to complete the required two-part application (financial eligibility form and service authorization request).
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