Higher Medicaid Income Limits Linked to Longer Cancer Survival

Mary Caffrey

Because Medicaid has always been a shared program between federal and state governments, there has been wide variation in income limits. Today, 38 states and the District of Columbia have Medicaid expansion.

States with higher Medicaid income limits—allowing more people to have health coverage—had better cancer survival rates among those newly diagnosed with cancer, according to study released this week ahead of the annual meeting of the American Society of Clinical Oncology (ASCO).

The study tracks 1.5 million adults who were diagnosed with cancer between 2010 and 2013, just before the effects of Medicaid expansion, allowed states to include households earning up to 138% of the federal poverty line (FPL). But some states opted not to participate, and because Medicaid has always been a shared program between federal and state governments, there has been wide variation in income limits for Medicaid over the past decade for adults aged 19 to 64 years.

Using the National Cancer Database, researchers tracked the patients through December 31, 2017, for up to 8 years of follow-up. They put states into 3 categories based on their Medicaid income limit: (1) 50% of the FPL or less, (2) 51% to 137%, or (3) 138% of the FPL or greater.

The study team compared results for 17 common cancers. Among those diagnosed with early-stage breast cancer, the death rate due to any cause was 31% higher in states with Medicaid income eligibility limits capped at 50% of FPL, and 17% higher in states with limits between 51% and 137% FPL, compared with similar patients in the 11 states with Medicaid income eligibility limits of 138% FPL or greater prior to 2014.

This is not the first study presented at ASCO linking Medicaid expansion to improvements in cancer care. A late-breaking abstract presented in 2019 found that expansion led to better cancer care for Black patients newly diagnosed with cancer, including the ability to get timely care.

Lead author Jingxuan Zhao, MPH, an associate scientist at the American Cancer Society, said the variation that exists today was present at the start of the study as well. In Texas, home to the largest number of uninsured, the Medicaid eligibility cap was only 27% of the FPL.

The number of states opting for Medicaid expansion has increased since 2014, and now stands at 38 plus the District of Columbia. The remaining 12 include some of the poorest states in the country, which have high rates of comorbidities. Congress recently offered more incentives to woo these states to expand Medicaid under the Affordable Care Act.

“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, FASTRO, FASCO.

“I think these data can be used to encourage those states who have chosen not to expand Medicaid coverage to strongly reconsider, since people who are uninsured are very likely to forego screening, and miss detection of early lesions, when a cure would be far more likely,” Pierce said.

“Those who are uninsured are unlikely to receive cancer care. And for those who are able to start cancer treatment, they're unlikely to complete their cancer here. So, equity of care is very, very critical.”

Reference

Zhao J, Han X, Nogueria L, et al. Association of state Medicaid income eligibility limits and long-term survival after cancer diagnosis in the United States. J Clin Oncol. 2021;39(suppl 15):6512. doi:10.1200/JCO.2021.39.15_suppl.6512