A study investigating the association between state Medicaid income eligibility limits and long-term survival among newly diagnosed patients with cancer has found that patients living in states with lower Medicaid income eligibility limits had worse long-term survival compared with patients living in states with higher income eligibility limits. The findings by Zhao et al were presented during a presscast in advance of the 2021 ASCO Annual Meeting (Abstract 6512).

Study Methodology

The researchers used data from the National Cancer Database to identify 1,425,657 adults aged 18 to 64 who were newly diagnosed with 17 common cancers between 2010 and 2013. They categorized states’ Medicaid income eligibility limits as ≤ 50%, 51% to 137%, and ≥ 138% of the federal poverty level. Survival time was measured from the date of diagnosis through December 31, 2017, for up to 8 years of follow-up.

Multivariable Cox proportional hazard models with age as time scale were used to assess associations of eligibility limits and stage-specific survival, controlling for age group, sex, race/ethnicity, metropolitan statistical area, number of comorbidities, year of diagnosis, facility type, and the random effect of state of residence.

Results

The researchers found among newly diagnosed patients with cancer aged 18 to 64, 22.0%, 43.5%, and 34.5% resided in states with Medicaid income eligibility limits ≤ 50%, 51% to 137%, and ≥ 138% of the federal poverty level, respectively. Compared with patients living in states with Medicaid income eligibility limits ≥ 138% of the federal poverty level, patients living in states with Medicaid income eligibility limits ≤ 50% and 51% to 137% of the federal poverty level were more likely to have worse survival for most cancers, both early- and late-stage.

The highest hazard ratios were observed among patients living in states with eligibility limits ≤ 50% of the federal poverty level (P trend < .05). For example, for women with early-stage breast cancer, the hazard ratios were 1.31 (95% confidence interval [CI] = 1.18–1.46) and 1.17 (95% CI = 1.06–1.30) for patients living in states with Medicaid income eligibility limits ≤ 50% and 51% to 137% compared to those living in states with Medicaid income eligibility limits ≥ 138% of the federal poverty level.

“Lower Medicaid income eligibility limits were associated with worse long-term survival within stage, with variation below the Medicaid eligibility threshold as part of the Affordable Care Act. States that have not expanded Medicaid income eligibility limits should expand them to help improve survival among [patients with] cancer,” concluded the study authors.

Ensuring Equal Cancer Care for All Patients

“[This] study clearly shows by the evidence that state expansion of Medicaid income eligibility limits is associated with better long-term survival in newly diagnosed patients,” commented ASCO President Lori J. Pierce, MD, FASTRO, FASCO, during a media presscast highlighting this study abstract.

Lori J. Pierce, MD, FASTRO, FASCO

“This is particularly relevant, since there are such variable limits among states regarding Medicaid expansion with the Affordable Care Act. I think these data can be used to encourage those states that have chosen not to expand Medicaid coverage to strongly reconsider, since people who are uninsured are very likely to forgo screening, so you miss the detection of early lesions when cure can be far more likely. Those who are uninsured are unlikely to receive cancer care and for those who are able to start cancer treatments, they are unlikely to complete their cancer care. Equity of care is very, very critical.”

Disclosure: There is no funding source reported for this study. For full disclosures of the study authors, visit coi.asco.org.