ASCO Calls for Major Medicaid Reform to Improve Quality Cancer Care for Low-Income Americans


Key Points

  • ASCO calls for Medicaid reform to close major gaps in coverage to ensure access to life-saving screening, treatment, and prevention services for low-income Americans with cancer.
  • ASCO’s policy recommendations include expanding eligibility to all 50 states, improving cancer screening and prevention services, and ending coverage restrictions that prevent Medicaid enrollees from receiving high-quality cancer care.
  • Low-income patients with cancer are in particular need of insurance coverage to allow for timely diagnosis and high-quality treatment.

ASCO issued its new Policy Statement on Medicaid Reform yesterday, which calls for major changes to the program to ensure access to high-quality cancer care for all low-income individuals. The Society’s recommendations call for Medicaid expansion in all 50 states to close coverage gaps, improve cancer screening and prevention services, and end coverage restrictions that prevent Medicaid enrollees from receiving high-quality cancer care, among others. The American Society of Clinical Oncology Policy Statement on Medicaid Reform was reported by Polite et al in the Journal of Clinical Oncology.

“People with cancer, for whom the costs of evaluation and treatment can be extraordinarily high, are particularly in need of insurance coverage to allow for timely diagnosis and high-quality treatment,” the authors wrote. Currently, 67.9 million Americans are enrolled in Medicaid. Of these, an estimated 2.1 million beneficiaries, including those added under the Affordable Care Act, have had a cancer diagnosis, and many more depend on Medicaid for routine cancer screenings and prevention services. Twenty-seven states and the District of Columbia have already expanded their Medicaid programs under the Affordable Care Act, 21 have not, and the remaining two states are in “open debate.”

“Policy debates over Medicare reform in the post-[Affordable Care Act] era threaten to exacerbate disparities in cancer care,” the authors wrote.

Drawing Attention to Critical Health-Care Disparities

During a press conference announcing the policy statement, Peter Paul Yu, MD, FACP, FASCO, ASCO President and Director of Cancer Research at Palo Alto Medical Foundation, explained why ASCO has decided to issue recommendations for Medicaid reform.

“The evidence shows that uninsured patients are significantly more likely to be diagnosed with advanced cancer than are insured patients. Further, Medicaid’s low reimbursement rates are a disincentive for physician participation, making it increasingly difficult for patients to access care from specialists,” said Dr. Yu. “As oncologists, we believe it is our responsibility to advocate for policies that expand and improve the care of all people with cancer regardless of financial means. We also believe that no individual diagnosed with cancer should be without insurance that guarantees access to high-quality cancer care delivered by a cancer specialist. Therefore, patients with cancer who have Medicaid should receive the same timely and high-quality cancer care as patients with private insurance. Lastly, Medicaid payments should be sufficient to ensure that Medicaid patients have access to quality cancer care.

“For these and other reasons, ASCO strongly believes that the Society should, first, draw attention to the critical issues facing cancer patients under Medicaid and, second, make concrete, constructive recommendations for strengthening this program to assure that our most vulnerable citizens receive needed health care. The ASCO Policy Statement on Medicaid Reform is designed to achieve both of those objectives,” said Dr. Yu.

Policy Recommendations

The recommendations ASCO presented in its policy statement offer several ways Medicaid could be reformed to expand access to cancer care and remove barriers to key elements of quality cancer care for enrollees. They include:

  • Expanding insurance coverage for individuals below the federal poverty level in all 50 states.
  • Ensuring oral parity for patients with Medicaid coverage and including oral and intravenous cancer therapies, as well as supportive care medications, as exempt services for cost-sharing purposes.
  • Extending clinical trial participation included in the Affordable Care Act to patients with Medicaid coverage, and allowing patients to cross state lines to participate in those trials.
  • Eliminating artificial barriers between current Medicaid beneficiaries and newly eligible ones, and applying Affordable Care Act final-rule mandates for cancer screening and diagnostic follow-up without copay for all Medicaid beneficiaries.
  • Requiring coverage for genetic testing, without deductibles or copays, in any patient deemed at high risk for an inheritable cancer-risk syndrome.
  • Improving the 340B Drug Pricing Program to incentivize care for the uninsured and underinsured and patients with Medicaid coverage, regardless of care setting.
  • Eliminating variation between Medicare and Medicaid physician payment rates for cancer diagnosis and treatment by raising Medicaid payment to Medicare rates.
  • Tying state flexibility in running Medicaid programs to the requirement to meet predefined cancer quality metrics.
  • Allowing oncology practices to be designated as medical homes, and developing expanded reimbursement for care coordination and patient education for oncology practices.

Blase N. Polite, MD, MPP, of the University of Chicago, is the corresponding author for the Journal of Clinical Oncology article.

Study author Nefertiti C. duPont reported a consultant or advisory role with Genentech, honoraria from DySIS Medical, and research funding from Genentech.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.