Cancer Patients in States with Strict Medicaid Eligibility Limits May Be Less Likely to Survive
Elizabeth Morey
There are multiple justifiable perspectives you can take on whether the United States should have expanded Medicaid coverage and whether they should continue to expand it, but you can't argue with the science when it comes to Medicaid's role in preventing cancer deaths. A 2021 study revealed that states with stricter Medicaid limits had greater long-term morbidity among cancer patients, suggesting that expanding Medicaid coverage could help save lives.
Jingxuan Zhao, MPH, associate scientist at American Cancer Society, led the study. She and her colleagues used the National Cancer Database to analyze 1,426,657 adults aged 18 to 64 years newly diagnosed with 17 common cancers. These records were dated from 2010 to 2013, before the implementation of Medicaid expansion under the Affordable Care Act.
“Income eligibility limits for Medicaid, the health insurance program for low-income populations in the United States, vary substantially by state for non-elderly adults,” said Zhao. “To date, little is known about the effects of Medicaid income eligibility limits on long-term cancer outcomes.”
The researchers grouped their subjects by whether the state they lived in had set the Medicaid income eligibility limit at 50% or less than the federal poverty level (22% of patients), 51% to 137% of the FPL (43.5% of patients), and greater than or equal to 138% of the FPL (34.5% of patients). They then measured each patient's survival time through the end of 2017.
The study was controlled for age group, sex, race/ethnicity, metropolitan statistical area, number of health conditions in addition to cancer, diagnosis year, facility type, and the random effect of state of residence. The results showed that states with lower income limits had worse survival outcomes for all cancers, including those at the earliest and latest stages of disease progression.
People residing in states with the strictest income eligibility limits for Medicaid had the worst survival rates, while those who lived in states with more lenient income limits had the best survival rates. The states in the middle for the most part had survival rates in the middle as well.
For example, when compared with fellow women with early-stage breast cancer who resided in a state with Medicaid income eligibility limits of 138% of the FPL or greater, those living in states with limits of 50% or less had a 31% higher rate of death due to any cause, whereas those living in states with limits of 51% to 137% had a 17% higher death rate.
A similar result was reported for women with late-stage breast cancer and patients with other cancers, such as prostate, colorectal, and non-small lung cancers.
It would appear that increased Medicaid access may lead to an increase in early cancer screening and earlier diagnoses. It also offers patients access to more affordable and specialized care, which translates to better survival. Researchers presented their findings at the 2021 virtual ASCO Annual Meeting.
“Policies to increase Medicaid income eligibility limits, such as Medicaid expansion, may help improve survival following cancer diagnosis,” said Zhao.
Since the time of this study, 38+ states and the District of Columbia have expanded their Medicaid income limits with the help of funding from the federal match provision provided in the Affordable Care Act.
“We plan to explore the association of Medicaid income eligibility limits and access to cancer treatment among newly diagnosed [patients with cancer] and to explore the association of Medicaid income eligibility limits and access to health care and affordability among cancer survivors,” Zhao continued. “We also plan to assess the effects of Medicaid expansion under the ACA and survival and mortality among [patients with cancer].”
We will see what further research shows about the effects of Medicaid expansion on patient survival, but for now, suffice it to say that things are looking promising.
