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F I S C A L I M P A C T R E P O R T

SPONSOR Carraro

ORIGINAL DATE

LAST UPDATED

01/24/208

HB

SHORT TITLE Low-Income Household Mammogram Vouchers

SB 199

ANALYST Geisler

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY08

FY09

$1,500.0

Recurring

General

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to: HB 35

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Health Policy Commission (HPC)

SUMMARY

Synopsis of Bill

Senate Bill 199 proposes an appropriation of $1,500,000 from the general fund to the

Department of Health for expenditure in fiscal year 2009. The Public Health Division would be

required to develop and implement a statewide voucher program to provide baseline

mammograms to women in low-income households. Any unexpended balance remaining at the

end of fiscal year 2009 would revert to the general fund.

FISCAL IMPLICATIONS

The funding in SB 199 was not a part of DOH’s executive budget request. SB 199 would

provide $1,500,000 in new funding for DOH. The estimated cost to implement the vouchering

program is $213,000 for three FTEs and associated administrative costs (i.e., $53,000

administrator, $36,000 billing specialist, $74,000 nurse, and $50,000 for administrative costs;

estimated start-up overhead for the three positions would amount to a total start-up cost of

$24,500).

Senate Bill 199 – Page

2

The Department of Health has requested expansion funding in the amount of $909.8 thousand for

a related program, the breast and cervical cancer screening program. Both the LFC and

executive recommendations include expansion funding for this item of $500 thousand.

SIGNIFICANT ISSUES

Approximately 1,100 women are diagnosed with invasive breast cancer each year in New

Mexico. During the same time period approximately 220 women will die from breast cancer.

These statistics do not include “in situ" cancers that have not invaded surrounding tissues.

Breast cancer is the most commonly diagnosed cancer among women in the state across all

racial/ethnic groups and accounts for one-third of all cancer cases in women. (New Mexico

Cancer Facts and Figures 2007, www.cancernm.org/cancercouncil/pdf/NMCFF_Facts-

figures07.pdf).

The most effective strategy for detecting early-stage breast cancer is undergoing a screening

mammogram every 1-2 years beginning at age 40 (United States Preventive Services Task Force,

2002). Slightly over 50% of all breast cancers diagnosed in New Mexico are detected at early

stages. One time only baseline mammography may not provide the same reduction in mortality

as annual screening.

A cooperative agreement between the Centers for Disease Control and Prevention (CDC) and

Department of Health (DOH) funds the New Mexico Breast and Cervical Cancer Early Detection

(BCC) Program. The BCC Program provides screening and diagnosis for women ages 30 – 64

who are uninsured or underinsured, and who live at or below 250% of the federal poverty level.

Based on recent analyses of census data (2006 Current Population Survey, Annual Social and

Economic Supplement), 90,804 New Mexican women, between the ages of 30 and 64, are

eligible to receive services from the BCC Program. However, current federal and state funding

levels are sufficient to serve only about 15% of those eligible women. Last year, the BCC

Program served 13,182 New Mexican women.

As currently written, the bill will provide “baseline" mammograms to women in low-income

households. The use of the term “baseline" implies a one time screening. However, the BCC

Program, by definition, is a re-screening program that is obligated to serve enrolled women every

year as long as they continue to meet eligibility criteria.

Currently, only women who are screened and diagnosed with breast cancer utilizing federal

funds provided through the DOH BCC Program may be eligible for treatment through the BCC

Program Medicaid 052. Importantly, while SB 199 would create a separate state-funded breast

cancer screening program, it does not provide for funding for subsequent diagnosis and

treatment. SB 199 does not provide for diagnostic follow-up or treatment services when

abnormalities are found on mammography. Women screened through the voucher program

proposed by SB 199 and subsequently diagnosed with breast cancer would not be eligible for

BCC Medicaid 052 to pay for the treatment of the disease. SB 199 would be strengthened by

addressing the provision of funding for diagnosis and treatment of women served through this

vouchering program.

Senate Bill 199 – Page

3

RELATIONSHIP

Senate Bill 199 relates to HB 35, which would provide DOH $500 thousand for breast and

cervical cancer screenings.

ALTERNATIVES

Instead of creating a new program, the bill could be amended to provide additional funding to the

DOH breast and cervical cancer program, which would allow women whose cancers are detected

thru the DOH program to receive treatment thru Medicaid.

GG/mt