Acceptance of Medicaid varies greatly among cancer care facilities
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Key findings:
- About two-thirds of Commission on Cancer-accredited facilities accepted new patients with Medicaid for colorectal, breast, kidney and skin cancer.
- Comprehensive community cancer programs had a lower likelihood of providing high access to patients with Medicaid.
- State Medicaid expansion status did not appear significantly associated with high access.
Although the number of Americans insured through Medicaid has increased during the past decade, barriers to cancer care access exist among Medicaid beneficiaries across high-quality centers, according to study results in JAMA Network Open.
Rationale and methods
“With a growing number of Americans with Medicaid insurance, there has been limited information to guide whether cancer care can be accessed at high-performing centers designated for cancer care,” Michael S. Leapman, MD, associate professor of urology and clinical program leader of the prostate and urologic cancers program at Yale Cancer Center, told Healio. “The rationale for this study was to examine whether cancer care services are accessible to patients with common cancer types who have Medicaid insurance.”
The national, cross-sectional secret shopper study included a random sample of 334 Commission on Cancer-accredited facilities in the U.S. in 2020, using a simulated cohort of Medicaid-insured adults with colorectal, breast, kidney and skin cancer.
Researchers telephoned patients with Medicaid who had a new cancer diagnosis and requested an appointment. They assessed the acceptance of Medicaid insurance for cancer care using descriptive statistics, chi-squared tests and multivariable logistic regression models. For the purpose of this study, researchers defined high-access hospitals as those offering care across all four common cancer types.
Key findings
Overall, 226 facilities (67.7%) provided high access to patients with Medicaid seeking cancer care.
Researchers found that 319 facilities (95.5%) accepted Medicaid insurance for breast cancer, 302 (90.4%) for colorectal cancer, 290 (86.8%) for kidney cancer and 266 (79.6%) for skin cancer.
Comprehensive community cancer programs had a significantly lower likelihood of providing high access to care for patients with Medicaid (OR = 0.4; 95% CI, 0.2-0.7). In contrast, investigators observed associations of high Medicaid acceptance with facilities that had nongovernment, nonprofit (OR = 3.5; 95% CI, 1.1-10.8) and government ownership (OR = 6.6; 95% CI, 1.6-27.2) vs. for-profit ownership, integrated salary models (OR = 2.6; 95% CI, 1.5-4.5), and average (OR = 6.4; 95% CI, 1.4-29.6) or below-average (OR = 8.4; 95% CI, 1.5-47.5) vs. above-average effectiveness of care.
Of note, researchers found no significant association between state Medicaid expansion status and high access.
Implications
“These findings indicate that despite increases in the number of Medicaid-insured Americans, barriers exist for accessing cancer care at high-performing centers,” Leapman told Healio. “These findings highlight gaps in cancer care access for the expanding population of patients with Medicaid and support accessibility as a quality metric for cancer care facilities.”
Despite documented benefits of Medicaid expansion, the impact of Medicaid coverage is blunted by racialized politics, clinician payment and stigma, according to an accompanying editorial by Amina P. Alio, PhD, Mitchell J. Wharton, PhD, and Kevin Fiscella, MD, MPH, researchers at University of Rochester.
“To achieve equitable access to quality cancer care, it will be imperative to revise racialized policies that directly affect clinician payment practices and patient access to care and indirectly fuel stigmatization and discriminatory behaviors toward Medicaid and its recipients,” they wrote.
References:
- Alio AP, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.22220.
- Marks VA, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.22214.
Michael S. Leapman, MD, can be reached at michael.leapman@yale.edu.
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