Male Patients with Breast Cancer Can't Get Medicaid Coverage

Raymond Johnson is 26 and has male breast cancer.  He works for a small construction company that does its best for him, but it doesn't provide health insurance.  When he turned to Medicaid for help covering the cost of treatments, he was turned down.  Medicaid rules vary by state and Johnson lives in South Carolina, where coverage for treatment of breast cancer is offered only to women.

Johnson and his mother had to absorb the shock of his cancer diagnosis and then the jolt of covering expenses with no assistance from their state.  He hoped the lump in his breast was a cyst, but when it became large and painful, he sought help.  A biopsy confirmed his breast cancer.  He went to the Charleston Cancer Center for surgery and to get help with other treatments.  It was there that he learned that he was on his own to cover the cost.  Fortunately, he met a patient advocate, Susan Appelbaum, experienced in working with state bureaucracy.  Appelbaum remarked, "Breast cancer is not exclusive to women, I know there's not near as many cases [in men] but it's certainly an issue to think about," she said. "What this 26-year-old man is going to endure, with chemo, radiation and surgery, we're talking about hundreds of thousands of dollars. This boy is never going to recover financially."

Currently, Johnson is having neo-adjuvant chemotherapy before surgery.  When chemo is given on this schedule, doctors hope to shrink the tumor and stop the possible spread of cancer.  A small tumor means less surgical trauma for the patient - male or female.  But the chemotherapy drugs are making it impossible for Johnson to continue working, as the side effects are debilitating.  His medical bills are already over $4000, just in the early stages of his treatment.  Medicaid has turned him down twice, but his patient advocate and the hospital remains positive about helping him with finances.

Appelbaum has appealed to Johnson's congressman and to local organizations that may be able to help change the laws and provide help with medical costs.  "It's always one day at a time," said Appelbaum. "We will continue to try our best because we want to help people, it's our job."  Meanwhile, the doctor bills and hospital bills continue to come in the mail.  Johnson now goes to Roper Saint Francis Hospital, a not-for-profit organization, for treatments.  He will not be denied treatment, and no collection agencies will be sent to dog him for money.  Johnson's patient advocate will help work out a payment plan that is adjusted to his current financial situation.Read more stories