Breast cancer patient denied coverage since he's a man

S.C. man met all criteria for a federal assistance program for breast cancer patients — except for being a woman

Although it's a well-established medical fact that men get breast cancer, Medicaid, the health insurance program for low income and disabled Americans, won’t provide coverage for some of them. Last month, Raymond Johnson, a 26-year-old single South Carolina man, discovered he was one of the estimated 2,100 men who are diagnosed with the disease each year.

“I didn’t even know men could get breast cancer,” says Johnson, who was diagnosed after he went to a local emergency room for chest pain treatment. “I’m young. I didn’t think anything bad could really happen to me.”

Johnson, a tradesman who made $9 an hour, worked for a small outfit that did not provide health coverage. With a bad economy, he only worked about 30 hours a week, and couldn’t afford private health insurance.

Since he didn’t qualify for traditional Medicaid, he was urged by the hospital where he is receiving care to apply for help under The Breast and Cervical Cancer Prevention and Treatment Act.

This 11-year-old federal law uses funds from Medicaid for breast or cervical cancer patients who otherwise don’t qualify for Medicaid because their income is too high, explains Jeff Stensland, spokesperson for the South Carolina Department of Health and Human Services.

The eligibility rules for coverage under the Act are complex, but Johnson met all criteria, except one: He isn’t a woman. “We want to cover this guy,” says Stensland, “but we simply can’t.”

Today, Johnson says he’s feeling “pretty good” but is undergoing chemotherapy and may need surgery to treat his Stage II cancer. He says he doesn't know how he's going to pay for his care.

“I just can’t tell you how floored I was when I got that letter saying I didn’t qualify for help," he says. "The bills are going to be huge. I have breast cancer. I really don’t see how that’s possible.”

This isn’t the first time the South Carolina Department of Health and Human Services has tried to get coverage under The Breast and Cervical Cancer Prevention and Treatment Act for male patients. Two other men in the last four years, who have also met the act’s criteria, have been denied coverage because they are, well, men.

"We’re in conversations with the federal government on this issue,” says Stensland. “It’s clearly discriminatory, and we believe it’s a good example of an overly rigid interpretation of the law, a law that’s designed to help patients with these cancers.”

In an email, a Centers for Medicare & Medicaid spokesperson tells

“The law governing this specific program is linked to a CDC screening program. We are working with the CDC and South Carolina to see what options may exist to address this situation. We are committed to ensuring that all individuals who should be eligible for this program have coverage.”