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Medicaid Eligibility Income Limits Affect Cancer Outcomes

Medicaid Eligibility Income Limits Affect Cancer Outcomes
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Published on August 24, 2021

Increased Medicaid Eligibility Associated With Lower Mortality

Medicaid is the largest source of funding for health-related services for people with low income in the United States. As of March 2021, nearly 75 million Americans were enrolled in Medicaid. Historically, individual states have determined income eligibility limits for Medicaid coverage, and whether you are considered eligible can differ depending on what state you live in.

A recent study showed that lower Medicaid income eligibility limits were associated with worse long-term survival within nonelderly patients newly diagnosed with cancer. The results were shared during the American Society of Clinical Oncology (ASCO) Annual Meeting held in June 2021.

“Income eligibility limits for Medicaid vary substantially by state for the nonelderly population. For example, the federal poverty line for a family of four in 2009 was only about $22,000. In Texas, the Medicaid income eligibility limit was only 27% of the federal poverty line in 2019. In New York, it was 150% of the federal poverty line,” said Jingxuan Zhao, MPH, a senior associate scientist with the American Cancer Society, during the ASCO meeting.

Using the National Cancer Database, Zhao and colleagues identified nearly 1.5 million adults ages 18 through 64 who were newly diagnosed with any of 17 common cancers between 2010 and 2013. Medicaid expansion under the Affordable Care Act was implemented starting in 2014, providing extra federal funding to states that expanded eligibility for Medicaid to people making up to 138% of the federal poverty line (FPL).

The researchers tracked the patients’ survival through the end of 2017. States were categorized by Medicaid income eligibility limits: no greater than 50% of the FPL, 51% to 137% of the FPL, and greater than 138% of the FPL.

Patients living in states with the lowest eligibility limits had the highest mortality rates, the researchers found. In patients with early-stage female breast cancer, the death rate due to any cause was 31% higher in states with Medicaid income eligibility no greater than 50% of the FPL and 17% higher in states with limits at 51% to 137% of the FPL, compared to similar patients in states with limits greater than 138% of the FPL.

“Similar patterns were also observed for late-stage female breast cancer and also other common cancer sites such as prostate, colorectal, and non-small cell lung cancers, and also observed among most other selected cancer sites in this study,” Zhao said.

“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 ASCO President Lori J. Pierce, MD, in a news release.

While the Affordable Care Act did lead to expanded Medicaid eligibility, there is still inconsistency in who qualifies for Medicaid within the U.S. Currently, 38 states and Washington, D.C., have expanded Medicaid eligibility, while 12 states have not.

“Policies to increase Medicaid income eligibility limits, such as Medicaid expansion, may help improve survival following cancer diagnosis,” Zhao said.

The cancer journey can be difficult to manage, and patients can ask about financial navigators during medical visits. These experts can help with understanding costs of care, obtaining insurance, appealing coverage rejections, and working with pharmaceutical companies to bring down the costs of expensive medications.

~Lauren Evoy Davis

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