Metastatic Cancer Diagnoses Drive Significantly Higher Medicaid Spending: Anuraag R. Kansal, PhD

For this week’s Managed Care Cast episode, The American Journal of Managed Care^® (AJMC^®) spoke with Anuraag R. Kansal, PhD, who leads health economics research at GRAIL, about his study, “State Medicaid Budgetary Implications of New Cancers," published in the July 2026 issue; it examined how new cancer diagnoses affected state Medicaid budgets.

He conducted the study with Amanda C. Chen, PhD, of the USC Mann School of Pharmacy and Pharmaceutical Sciences, and David C. Grabowski, PhD, of Harvard Medical School.

Kansal explained to AJMC that despite Medicaid's younger population, cancer remains the third-largest source of program spending. Most existing research had focused on commercial and Medicare populations rather than Medicaid specifically. Consequently, using de-identified CMS claims data, he and his team identified new cancer diagnoses, defined as no prior cancer evidence in the preceding 6 months, and compared spending, hospitalizations, and emergency department use between metastatic and nonmetastatic cases.

Kansal highlighted the core finding, which was that metastatic diagnoses were associated with significantly higher spending than nonmetastatic diagnoses across most cancer types. Notably, health care utilization patterns were consistent between fee-for-service and capitated Medicaid states, suggesting that cost drivers stemmed from the disease itself, particularly the shift to systemic therapies once cancer spread, rather than from program administration models.

Kansal pointed to the 4 cancer screenings recommended by the US Preventive Services Task Force—lung, breast, colorectal, and cervical—as opportunities to reduce late-stage diagnoses and their associated costs. By contrast, he noted that cancers without established screening protocols presented a distinct policy challenge.

On balancing innovative treatment access with cost sustainability, Kansal emphasized that Medicaid's state-by-state administration means that no single policy solution applies universally. Still, he emphasized that earlier detection could offer states greater financial flexibility to support innovative therapies for patients with true clinical need.

“Intervening earlier is one of the opportunities we might have to really make a difference,” Kansal concluded.

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