OBJECTIVES: Cervical cancer (CC) is the 11th most common cancer among American women. In West Virginia (WV), it is second most common cancer and also second leading cause of cancer-related mortality in 25-44 years aged women. The study objective was to use claims data for surveillance of CC and precancerous cervical intraepithelial lesions (PCL) among women enrolled in the state Medicaid Fee-For-Service program. METHODS: Enrollment, demographic, and claims data for continuously enrolled female recipients aged 18-64 years for the period 2003 to 2008 were analyzed for this study. All medical claims were aggregated to reflect each recipient’s medical utilization.  RESULTS: Pap smear testing prevalence declined between 2003 (238.9/1,000) and 2008 (158.8/1,000).  During the study period, approximately 58% women had at least 1 Pap smear test. While prevalence of CC diagnosis declined from 139 to 113 during the study period, the prevalence of cervical intraepithelial neoplasia-1 (CIN1) and CIN2 increased to 85 and 207 from 2003 to 2008, respectively.  Approximately 73% of the women received Pap testing during the 365 day period prior to their index date of CC or PCL diagnosis. Poisson regression model found age, race, location, contraceptive use, access to provider and co-morbidity status as significant (p<.05) predictors of persistence with Pap testing. Ordinal logistic regression model predicted Pap screening persistence as a significant factor that was associated with the likelihood of an initial diagnosis of CC, high grade PCL, or low grade PCL. Only 10% of the women received appropriate follow-up care following a diagnosis of low grade PCL; for high grade PCL diagnosis 32% of the women received appropriate follow-up care. CONCLUSIONS: The study found declining screening rates for CC during the study period in fee-for-service Medicaid population. Disparities in appropriate follow-up care following a diagnosis of high grade or low grade PCL were also identified.