In a study reported in JAMA Network Open, Marks et al found that only two-thirds of a sample of U.S. Commission on Cancer–accredited cancer care facilities accepted Medicaid insurance for the treatment of four common cancers in a simulated cohort of adult patients with newly diagnosed disease.
Study Details
The study, conducted in 2020, involved a randomly selected sample of 334 cancer care facilities and a simulated cohort of Medicaid-insured patients with colorectal, breast, and kidney cancer and melanoma. Telephone calls were made to the facilities to request an appointment for a patient with Medicaid with a new cancer diagnosis. Facility-level factors potentially associated with Medicare acceptance were obtained from the 2016 American Hospital Association Annual Survey and Centers for Medicare & Medicaid Services General Information database.
Key Findings
Of the 334 facilities, 226 (67.7%) accepted Medicaid for all four cancer types, with acceptance for all four types defined as high access to care. Medicaid was accepted for breast cancer in 319 facilities (95.5%), colorectal cancer in 302 (90.4%), kidney cancer in 290 (86.8%), and melanoma in 266 (79.6%).
National Cancer Institute–designated cancer programs were more commonly high access (26 of 29 [89.7%]), followed by academic comprehensive (38 of 44 [86.4%]), community (56 of 75 [74.7%]), integrated network (25 of 36 [69.4%]), and comprehensive community (81 of 150 [54.0%]) cancer programs (overall P < .001). On multivariate analysis, comprehensive community cancer programs were significantly less likely to provide high access to care (odds ratio [OR] vs community programs as referent = 0.4, 95% confidence interval [CI] = 0.2–0.7, P = .007).
Facilities that were significantly more likely to provide high access included those with: nongovernment, nonprofit ownership (OR vs for-profit ownership = 3.5, 95% CI = 1.1–10.8, P = .03) and government ownership (OR vs for-profit = 6.6, 95% CI = 1.6–27.2, P = .01); those with integrated vs no integrated salary models (OR = 2.6, 95% CI = 1.5–4.5, P = .001); and those with average effectiveness of care (OR vs above-average = 6.4, 95% CI = 1.4–29.6, P = .02) or below-average effectiveness of care (OR vs above-average = 8.4, 95% CI = 1.5–47.5, P = .02). State Medicaid expansion status was not significantly associated with high access (OR vs nonexpansion status = 1.3, 95% CI = 0.7–2.3, P = .47).
The investigators concluded: “This study identified access disparities for patients with Medicaid insurance at centers designated for high-quality care. These findings highlight gaps in cancer care for the expanding population of patients receiving Medicaid.”
Michael S. Leapman, MD, Department of Urology, Yale University School of Medicine, is the corresponding author for the JAMA Network Open article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
