For Medicaid-Insured Patients with Cancer, Health Insurance Does Not All the time Mean Health Access

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Although there was a big increase within the variety of U.S. residents insured through Medicaid because the expansion of the Patient Protection and Afforadble Care Act (ACA) in March 2010, the flexibility of Medicaid-insured patients to access cancer care services has not been well understood. In a study published today within the journal JAMA Network Open, researchers at Yale Cancer Center assessed the acceptance of Medicaid insurance amongst patients diagnosed with common cancers.

“We found that Medicaid acceptance differed widely across cancer care facilities, with a considerable variety of centers not offering services to patients with Medicaid insurance,” said Michael Leapman, MD, MHS, Associate Professor of Urology, Clinical Program Leader for the Prostate & Urologic Cancers Program at Yale Cancer Center and Smilow Cancer Hospital, and senior writer on the study.

Within the study led by first-author Victoria Marks, a second-year medical student at Yale, 334 Commission on Cancer-accredited facilities were sampled, of which, only 226 (67.7%) accepted latest patients with Medicaid insurance for the 4 common cancers chosen (colorectal, breast, kidney, and skin). Acceptance varied among the many facilities, with 296 (88.6%) accepting Medicaid for not less than three types, 324 (97.0%) for not less than two, and 331 (99.1%) for not less than one type. Collectively, these findings underscore the persistent gaps that exist for patients with Medicaid in utilizing services at hospitals distinguished for high-quality cancer care.

“This study underscores that having medical insurance alone doesn’t necessarily mean that patients can practically access healthcare. While major recent expansions of Medicaid have led to increases in medical insurance coverage for Americans with cancer, now we have to remember and do more to be certain that insurance will actually translate to timely and high-quality care,” said Dr. Leapman.

Facilitates that were more likely than others to just accept patients with Medicaid included National Cancer Institute (NCI)-designated cancer centers, 89.7% of which offered high access to patients with Medicaid, and academic centers (86.4%). Furthermore, facilities positioned in states that expanded Medicaid were also more more likely to offer high access to Medicaid patients, 71.3% versus 59.6%.

“The outcomes of this study don’t necessarily mean that patients won’t have the ability to access care anywhere, but may require a circuitous and impractical path, and will not be seen at centers designated for cancer care,” Dr. Leapman explained.

In keeping with Dr. Leapman, finding solutions that increase access for Americans with Medicaid will probably be complex. “Despite a big increase within the variety of Medicaid-insured patients, most aspects that limit a hospital or physician’s participation in Medicaid haven’t modified,” he said. “These include low reimbursement, high administrative burden, and limited specialist participation in managed care organization networks. Even modest increases in reimbursement can have a positive impact, and progress in payment structures that prioritize healthcare quality are promising as well. Still, identifying these gaps in access is a vital first step that may direct awareness.”

Additional Yale authors include Michelle Salazar, Elizabeth Berger, and Daniel Boffa.

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