Researchers Examine Cancer Outcomes Associated with Medicaid Expansion

Recently published collaborative research investigated patients’ primary care utilization and the association with early-stage cancer diagnosis and survival outcomes for Medicaid enrollees. “Association of Medicaid Enrollee Characteristics and Primary Care Utilization with Cancer Outcomes for the Period Spanning Medicaid Expansion in New Jersey” was published in the journal Cancer. The study sought to examine cancer outcomes that may be affected by primary care and other outpatient care utilization for Medicaid enrollees. 

The study utilized data from the New Jersey State Cancer Registry (NJSCR) and the New Jersey Medicaid Management Information Systems to conduct a retrospective cohort study for 3,253 patients with incident breast (female only), colorectal, or invasive cervical cancer (aged 21 - 64) diagnosed between 2012 and 2014. The study team examined late-stage diagnoses, treatment delays, and 2-year survival rates.

They found that Medicaid enrollees diagnosed with cancer just before and in the initial year of Medicaid expansion are significantly more likely to have late-stage disease and lower 2-year survival in comparison with corresponding non-Medicaid cases. Within the Medicaid cohort, primary care utilization prior to a cancer diagnosis is associated with earlier stage detection and less delay in treatment. Newly enrolled Medicaid patients had higher odds of late-stage disease and treatment delays and lower survival than longer-term enrollees in Medicaid managed care plans. The results show that late-stage diagnoses of breast cancer and colorectal cancer were more frequent among newly enrolled Medicaid cases than non-Medicaid cases. 2-year survival rates were low among newly enrolled Medicaid cases in comparison with established Medicaid cases and non-Medicaid cases. 

The findings emphasize the importance of outpatient utilization and improved access to primary care providers among Medicaid patients. In conclusion, “Targeted strategies to enhance care continuity, including access to PC providers before the diagnosis and a better understanding of pathways to cancer care upon Medicaid enrollment, are needed to improve outcomes in this population.”

This research was funded by a Rutgers Cancer Institute of New Jersey Cancer Prevention and Control Pilot Award (P30CA072720) from the National Cancer Institute, the American Cancer Society, the National Cancer Institute, and Centers for Disease Control and Prevention.

The research team included Derek DeLia, PhD, from MedStar Health Research Institute in collaboration with researchers from the Cancer Institute of New Jersey, School of Public Health, Center for State Health Policy, and the Robert Wood Johnson Medical School, all part of Rutgers, the State University of New Jersey. Additional collaborators were from the New Jersey State Cancer Registry.

Cancer, 2019. DOI: 10.1002/cncr.31824