Services Widely Differ for Patients With Cancer Who Have Medicaid Coverage

Disparities exist for Medicaid-insured patients at centers designated for high-quality care, according to researchers from Yale Cancer Center.

Though number of United States residents insured through Medicaid has increased significantly over previous years, barriers to accessing cancer care still exist at high-quality centers, according to data published in the JAMA Network Open journal.1

Researchers at the Yale Cancer Center assessed the acceptance of Medicaid insurance among patients diagnosed with colorectal, breast, kidney, and skin cancer to find that insurance acceptance varied across treatment centers.

“We found that Medicaid acceptance differed widely across cancer care facilities, with a substantial number of centers not offering services to patients with Medicaid insurance,” said Michael Leapman, MD, MHS, associate professor of urology, clinical program leader for the Prostate & Urologic Cancers Program at Yale Cancer Center and Smilow Cancer Hospital, and senior author on the study, in a press release.2

Of the 334 Commission on Cancer-accredited facilities, 226 (67.7%) accepted new patients with Medicaid insurance for the 4 cancer types analyzed. The facilities had varying acceptance rates according to the cancer types, including 296 (88.6%) which accepted Medicaid for at least 3 of the disease types, 324 (97.0%) that accepted for at least 2 types, and 331 (99.1%) that accepted at least 1 type.

These findings highlight the inconsistencies among Medicaid catered services at cancer care centers. Hospital-level Medicaid acceptance included 302 facilities (90.4%) accepting colorectal, 319 facilities (95.5%) accepting breast, 290 (86.8%) for kidney, and 266 (79.6%) for skin cancer.

“This study underscores that having health insurance alone does not necessarily mean that patients can practically access healthcare. While major recent expansions of Medicaid have led to increases in health insurance coverage for Americans with cancer, we have to be aware and do more to ensure that insurance will actually translate to timely and high-quality care,” added Leapman.

High access to patients with Medicaid coverage were more likely accepted at National Cancer Institute-designated cancer centers (89.7%), academic centers (86.4%), followed by community centers (74.7%), integrated network facilities (69.4%), and comprehensive community cancer programs (54.0%). High access acceptance was less likely observed at for-profit hospitals (42.1%) than nongovernment, nonprofit (69.6%) and government facilities (79.5%). Researchers also noted that facilities in the US who expanded Medicaid were more likely to offer high access to Medicaid patients compared to states who did not expand Medicaid (71.3% vs 59.6%, respectively).

“The results of this study do not necessarily mean that patients will not be able to access care anywhere, but may require a circuitous and impractical path, and may not be seen at centers designated for cancer care,” Leapman said. “Despite a large increase in the number of Medicaid-insured patients, most factors that limit a hospital or physician’s participation in Medicaid have not changed. These include low reimbursement, high administrative burden, and limited specialist participation in managed care organization networks. Even modest increases in reimbursement may have a positive impact, and progress in payment structures that prioritize healthcare quality are promising as well. Still, identifying these gaps in access is an important first step that can direct awareness.”

The study concluded that facilities with integrated salary models had greater access for patients with Medicaid. Physicians within integrated systems were more willing to see patients with Medicaid when compensation is based on salary or work-relative value regardless of patient insurance status.1

References
1. Marks VA, Hsiang WR, Nie J, et al. Acceptance of simulated adult patients with medicaid insurance seeking care in a cancer hospital for a new cancer diagnosis. JAMA Netw Open. 2022;5(7):e2222214. Published 2022 Jul 1. doi:10.1001/jamanetworkopen.2022.22214
2. For medicaid-insured patients with cancer, health insurance does not always mean health access. Press release. Yale School of Medicine. July 15, 2022. Accessed August 4, 2022. https://bit.ly/3bsCXge