Medicaid Beneficiaries Face Barriers to Cancer Care Access

Despite the growing number of people receiving healthcare coverage from Medicaid, Medicaid beneficiaries faced barriers to accessing cancer care at high-quality facilities, a study published in JAMA Network Open found.

Medicaid beneficiaries with cancer may experience care access barriers due to limited hospital or physician participation in Medicaid. Hospital and physician participation may be slim due to low reimbursement, high administrative burden, or limited specialist participation in managed care organization networks.

To evaluate access to cancer care for Medicare beneficiaries at Commission on Cancer (CoC)-accredited hospitals, researchers conducted a secret shopper study between March and November 2020.

Investigators contacted specialty departments at facilities posing as individuals seeking care for Medicaid beneficiaries with a new cancer diagnosis. The study focused on colorectal, breast, kidney, and skin cancer.

Of the 334 facilities researchers contacted, 226 or 67.7 percent accepted Medicaid for all four cancer types. Acceptance was higher among facilities that did not accept Medicaid for all the cancer types.

For example, 296 facilities (88.6 percent) accepted Medicaid for at least three cancer types and 324 facilities (97 percent) accepted Medicaid for at least two cancer types. Most facilities (334 facilities) accepted Medicaid for at least one cancer type.

Medicaid acceptance was highest for colorectal cancer, with 90.4 percent of facilities (302 facilities) accepting the insurance for patient care. The acceptance rate was 95.5 percent (319 facilities) for breast cancer, 86.8 percent (290 facilities) for kidney cancer, and 79.6 percent (266 facilities) for skin cancer.

“These findings may suggest that acceptance policies are primarily driven by individual departments rather than a singular facility standard, indicating that practice preference may play a role in Medicaid acceptance,” the study stated.

As cancer treatment may involve multidisciplinary approaches, variation in Medicaid acceptance among departments may lead to fragmented care, researchers noted. More consistency in Medicaid acceptance could help promote higher-quality, integrated care.

Certain characteristics were associated with high-access facilities, researchers found. High-access facilities were more likely to be located in states that had expanded Medicaid compared to nonexpansion states (71.3 percent versus 59.6 percent).

In addition, National Cancer Institute (NCI)-designated cancer programs were more likely to be high-access, as were academic comprehensive, community, integrated network, and comprehensive community cancer programs.

However, the study noted that comprehensive community cancer programs were less likely to accept Medicaid than community cancer programs for colorectal, kidney, and breast cancer.

Nonprofit (69.6 percent) and government facilities (79.5 percent) were more likely to be high-access facilities than for-profit hospitals (42.1 percent). Major teaching hospitals and hospitals with medical school affiliations also had a higher likelihood of accepting Medicaid beneficiaries.

Researchers found associations between Medicaid acceptance and integrated salary models, accountable care organizations, and higher total facility admissions.

“Collectively, these findings underscore persistent gaps that exist for patients with Medicaid in accessing hospitals distinguished for high-quality cancer care,” the study stated.

Increasing Medicaid reimbursement rates and implementing payment reform models that incentivize healthcare quality may help increase Medicaid acceptance. Integrated salary models may have been associated with higher care access as physicians may be more willing to see Medicaid beneficiaries when compensation is based on salary or work-relative value units regardless of insurance status, researchers suggested.