Medicaid Expansion Improved Palliative Care Access for Cancer Patients

Medicaid beneficiaries with late-stage cancer might have greater access to palliative care in states that have adopted Medicaid expansion, a study published in Health Affairs found.

The researchers leveraged the National Cancer Database to perform this assessment. The individuals in the sample were between the ages of 18 and 64. Each participant had been diagnosed with the early phase of stage IV cancer between 2010 and 2019. The database tracked their health outcomes until the date of death or the end of 2019.

The researchers noted that their sample might have underestimated the amount of palliative care patients received because certain services were not included in the database. Additionally, the data was not as granular about certain patient demographical factors.

The most common types of cancer in the sample were lung, colon and rectum, oral cavity and pharynx, non-Hodgkin lymphoma, and pancreas cancer. Of the patients studied, over 439,100 patients were from expansion states, and almost 246,640 were from nonexpansion states. Nonexpansion state participants were more likely to be non-Hispanic Black, low-income, not metropolitan, and uninsured.

Individuals in states that adopted Medicaid expansion were more likely to receive palliative care than those in nonexpansion states.

However, in both scenarios, the share of patients with advanced-stage cancers that received palliative care increased over time. In 2010, 16.1 percent of advanced-stage cancer patients in expansion states received palliative care, but by 2019 this share increased to 21.0 percent. In nonexpansion states, the share of individuals who received palliative care grew from 15.6 percent to 18.9 percent over that same nine-year period.

“The gap in percentage receiving palliative care between expansion and nonexpansion states widened after the implementation of Medicaid expansion commenced,” the researchers stated.

Individuals who were younger, Hispanic, high-income, and did not have comorbidities were less likely to receive palliative care. Rates of palliative care increased among older individuals (55 to 64 years), non-Hispanic White, and living in non-metropolitan areas.

The researchers concluded that palliative care treatment was dissatisfactory, despite the growth in uptake over the years. Although studies recommend the early introduction of palliative care to improve patient experience and patient satisfaction, most patients did not receive palliative care at all. Only around one in five received palliative care.

Nevertheless, the researchers found that expanding Medicaid increased care access among advanced-stage cancer patients. The study suggested that Medicaid beneficiaries may have lower financial barriers in access to palliative care due to Medicaid expansion. Additionally, they may have greater access to value-based care coverage of these services.

“Expanding insurance coverage, and specifically Medicaid coverage, may be a promising policy lever to improve the use of palliative care,” the study stated.

Medicaid expansion has been extensively studied for its impact on patient outcomes and states’ healthcare spending. Previous studies explored the impact that this policy could have on overall uninsurance rates in the US and health equity, evictions and housing security, mortality rates, and more.