Published Online: August 25, 2014
Mary K. Caffrey
While all states have Medicaid, not all Medicaid programs have the same benefits. A study published today in Cancer
the journal of the American Cancer Society, examined how differences in reimbursement for office visits and for screenings themselves play out in the percentages of patients who are screened for common cancers.
The authors, led by Michael T. Halpern, MD, PhD, note that while state Medicaid programs cover cancer screening programs, Medicaid beneficiaries are less likely to be screened for cancer. Thus, these patients are more likely to be diagnosed when their tumors have already reached a more advanced stage than those with other forms of health insurance. Halpern and his co-authors sought to determine how reimbursement policies affected the receipt of breast, cervical and colon cancer screenings.
Their cross-sectional regression analyses covered 2007 Medicaid data from 46 states and the District of Columbia. They found that increases in payment for the test itself had mixed associations, both positive and negative, with whether patients were screened. However, increases in payments for office visits increased the odds that patients would receive all tests for which they were eligible, including the colonoscopy. The authors write that keeping track of how well states and health plans reimburse for office visits for Medicaid patients “may be an important policy tool for increasing screening among this vulnerable population.” This is especially true, they write, as millions of new Medicaid beneficiaries see doctors for routine screenings for the first time under the Affordable Care Act.
The authors note that payment for office visits is but one of a host of variables that work in concert to make Medicaid available to the poor at the state level, and these variables will evolve as the ACA unfolds across the country. States will see the effects of decisions to expand or not expand Medicaid eligibility on the ground.
“As states expand Medicaid eligibility, it will be important to track state-specific changes in Medicaid enrollment, reimbursement rates, and eligibility requirements, and their impact on cancer screening, diagnosis at an early stage, and survival among individuals diagnosed with cancer,” they write.
The series Status in the States, appearing in Evidence Based Oncology
, a publication of The American Journal of Managed Care,
looked at differences in Medicaid availability in two high-cancer states, Kentucky and Louisiana, and the potential impact of choices to expand or not expand it under the ACA. As reported Friday in AJMC.com, Kentucky Governor Steve Beshear is crediting Medicaid expansion for helping patients catching cancers early. In Louisiana, healthcare advocates have criticized Governor Bobby Jindal for reversing a previous position calling for Medicaid expansion, saying it will cost lives among the poor.
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Halpern MT, Romaire MA, Haber SG, et al. Impact of state-specific Medicaid reimbursement and eligibility policies on receipt of cancer screening. Cancer. Published online ahead of print August 25, 2014. DOI: 10.1002/cncr.28704