In 1945, the NC General Assembly created the NC Cancer Control Program to “establish and administer a program for the prevention and detection of cancer and the care and treatment of persons with cancer” (General Statutes 130A-205).  In its first years, the program was funded by a grant from the American Cancer Society, but in 1947 the State assumed funding of the program, with an initial appropriation of $36,700.  Over the last 63 years, the program budget has grown to $2,531,934 in fiscal year 2008 for direct services to patients.

Historically, the Cancer Control Program covered a range of cancer prevention, early detection, diagnostic and treatment services.  In the years since the program was established, cancer prevention and early detection activities have been assumed by other programs within the NC Division of Public Health, and the focus of the Cancer Control Program has shifted toward financial assistance for diagnostic testing and treatment.  In recent years, the program was re-named the Cancer Assistance Unit, to reflect this change in emphasis.  Since that time, payment for diagnostic and treatment services for low-income, uninsured patients has been the sole mission of the program.

The NC Cancer Control Program was the first program in the nation to provide funds for treatment of low-income, uninsured patients with cancer, and the program still has few peers nationally.  Similar programs exist in Georgia (Cancer State Aid) and Delaware (the Delaware Cancer Treatment Program). We are unaware of comparable programs in any other States.

Accomplishments
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).