Restrictive Medicaid Eligibility May Negatively Impact Cancer Survival


States without Medicaid expansion tended to have poorer cancer outcomes than states with higher income limits on eligibility, according to recent research.

In states with more restrictive Medicaid eligibility, patients with cancer tended to have poorer long-term outcomes than those with higher income limits to qualify. Findings from this study were presented in a media webcast before the 2021 ASCO Annual Meeting.

“Policies to increase Medicaid income eligibility limits such as Medicaid expansion may help improve survival following cancer diagnosis,” Jingxuan Zhao, MPH, associate scientist with the American Cancer Society, said during the webcast.

Income eligibility limits for Medicaid varies substantially by state for non-elderly patients, according to the presentation. For example, the federal poverty line for a family of four in 2009 was $22,050. The Medicaid eligibility limit was 27% of the federal poverty line in Texas, whereas this limit was 150% for New York.

With this study, researchers aimed to assess the associations between state Medicaid income eligibility limits and long-term survival in patients with newly diagnosed cancer. This was analyzed with data from an estimated 1.5 million adults from the National Cancer Database aged 18 to 64 years who were newly diagnosed with 17 common cancers between 2010 and 2013. Patients were followed up through the end of 2017 for up to 8 years of follow-up.

State Medicaid income eligibility limits were categorized as less than 50% of the federal poverty line, between 51% and 137% of the federal poverty line and greater than 138% of the federal poverty line.

When patients with all cancer types were combined, patients who lived in states with the low Medicaid income eligibility limits had the worst survival rates compared with those who lived in states with high limits. This was seen for patients with stages 1 and 2 cancers and in those with stages 3 and 4 cancers.

Similar findings were observed when data were categorized by cancer type. For example, compared with states with eligibility limits greater than 138%, women with stage 1 and 2 breast cancer in states with a limit less than 50% (adjusted HR = 1.31; 95% CI, 1.18-1.46) and limits between 51% and 137% (adjusted HR = 1.17; 95% CI, 1.06-1.3) had worse long-term survival. This was also seen in women with stage 3 and 4 breast cancer (adjusted HR for less than 50% = 1.21; 95% CI, 1.1-1.33; adjusted HR for 51% to 137% = 1.13; 95% CI, 1.03-1.23).

Researchers also observed similar findings for other common cancers including prostate, colorectal and non-small cell lung cancers.

“[These findings are] particularly relevant … since there [are] such variable limits among states regarding Medicaid expansion with the [Affordable Care Act],” Lori J. Pierce, MD, FASTRO, FASCO, radiation oncologist, professor and Vice Provost for Academic and Faculty Affairs at the University of Michigan in Ann Arbor and director of the Michigan Radiation Oncology Quality Consortium, said during the discussion after the presentation. “I think these data can be used to encourage those states who have chosen not to expand Medicaid coverage to strongly reconsider because people who are uninsured are very likely to forego screening, so you miss the detection of early lesions where cure would be far more likely. 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 care. Equity of care is very, very critical.”


Zhao J, et al. Association of State Medicaid Income Eligibility Limits and Long-Term Survival After Cancer Diagnosis in the United States. Presented at: 2021 ASCO Annual Meeting; June 4-8, 2021; Virtual. Abstract 6512.

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