Patients With Newly Diagnosed Cancer Live Longer in States With Higher Medicaid Income Limits

ASCO Perspective

“This study shows that states with expanded Medicaid income eligibility limits have improved cancer survival rates, consistent across cancer type and stage. Health insurance coverage is associated with improved access to cancer prevention, diagnosis, and treatment, allowing us better opportunities to provide the right care to the right patient at the right time,” said Lori J. Pierce, MD, FASTRO, FASCO.

San Francisco, CA (UroToday.com) -- Survival for patients with newly diagnosed cancer is longer in states with higher Medicaid income eligibility limits.

Study at a Glance

Focus: Association between state Medicaid income eligibility limits with long-term cancer survival rates.

Population: Nearly 1.5 million adults, who were newly diagnosed with one of 17 common cancers between 2010 to 2013.

Findings: Higher Medicaid income eligibility limits – expressed as a percentage of the federal poverty level (FPL) – were associated with better long-term survival within stage for patients newly diagnosed with cancer.

Significance: Medicaid is the largest source of funding for medical and health-related services for people with lower income in the United States. One provision of the Affordable Care Act (ACA) enacted in 2014 helped states expand Medicaid coverage for low-income, non-elderly adults up to 138% of the FPL. However, not all states have adopted Medicaid expansion.

The study will be presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting.

Key Findings

According to a new study examining the association between state Medicaid eligibility limits and long-term survival of patients newly diagnosed with cancer, higher Medicaid income eligibility limits were associated with better long-term survival than patients in states with lower eligibility limits. Researchers also determined that this association was consistent across a variety of cancers and for patients with both early- and late-stage disease at diagnosis.

Income eligibility limits for Medicaid, the health insurance program for low-income people in the United States, vary substantially by state for non-elderly populations.

“To date, little has been known about the effects of Medicaid income eligibility limits on cancer outcomes. Our research provides strong evidence that state expansion of Medicaid is associated with better long-term survival among newly diagnosed cancer patients,” said lead author Jingxuan Zhao, MPH, who is an associate scientist at the American Cancer Society.
In one example of the association between income eligibility limits and cancer survival, the researchers found that among patients diagnosed with early-stage breast cancer between 2010-2013 and followed through 2017, the rate of deaths due to any cause was 31% higher in states with Medicaid income eligibility limits no greater than 50% the FPL, and 17% higher in states with limits between 51-37% FPL, compared with similar patients in the 11 states with Medicaid income eligibility limits of 138% FPL or greater prior to 2014.

Thirty-nine states (including the District of Columbia) currently have expanded Medicaid income limits, supported in part with a federal match included in the ACA.

About the Study

Using the National Cancer Database, researchers identified nearly 1.5 million adults, all newly diagnosed with one of 17 common cancers between 2010 to 2013 – before the implementation of Medicaid expansion under the ACA.

Survival time was measured from diagnosis to December 31, 2017, for up to 8 years of follow-up. States were categorized by Medicaid income eligibility limits as a percentage of the FPL:

50% of the federal poverty or less
51%-137% of the federal poverty level
138% of the federal poverty level or greater

Next Steps

Going forward, the researchers are planning to use the same database to explore the association of Medicaid income eligibility limits and access to cancer treatment among newly diagnosed cancer patients. They’ll also use nationally representative survey data to explore the association of Medicaid income eligibility limits and access to healthcare and affordability among cancer survivors.

Additional analyses may include: the association between Medicaid income eligibility limits and other outcomes, such as stage at cancer diagnosis and receipt of cancer treatment, and if cancer outcomes differ by race/ethnicity, area-level poverty, and Medicaid Savings Account.

Source: "Patients With Newly Diagnosed Cancer Live Longer In States With Higher Medicaid Income Limits". 2021. ASCO. 
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