Medicaid Expansion Boosted Medicaid Enrollment Among Some Older Older Patients

An analysis prepared by researchers at the American Cancer Society (ACS) and presented at the 2024 American Society of Clinical Oncology (ASCO) Quality Care Symposium shows Medicaid expansion under the Affordable Care Act was associated with an increase in Medicaid enrollment among patients aged ≥65 years old were diagnosed with cancer.¹

In the study, Kewei Sylvia Shi, an associate scientist in health services research at the ACS, and other researchers identified patients from the National Cancer Data Base who were aged ≥65 years old who had been diagnosed with cancer between 2010 and 2022 and were residing in areas with a median income below 200% of the federal poverty level. The researchers compared the changes in the percentage of dual-eligible or Medicaid-only coverage post Medicaid expansion in expansion versus nonexpansion states. Analyses were also stratified by key demographic characteristics.

The percentage of patients with dual or Medicaid-only coverage increased from 16.84% to 18.09% in expansion states and dropped from 14.14% to 12.62% in nonexpansion states.

Researchers identified 256,997 patients with cancer, with 136,373 patients from expansion states and 120,624 patients from nonexpansion states. After adjusting for sociodemographic characteristics, the percentage of patients with dual or Medicaid-only coverage increased from 16.84% to 18.09% in expansion states and dropped from 14.14% to 12.62% in nonexpansion states. Differences were more pronounced among patients diagnosed with stage III-IV cancers, identified as non-Hispanic Black, residing in metropolitan areas, with ≥2 comorbidities, and treated in comprehensive or academic cancer centers.

Although not the target population of Medicaid expansion under the Affordable Care Act, researchers concluded that older individuals may benefit from Medicaid expansion through the indirect increase in enrollment, particularly for those who are low-income and eligible for both Medicaid and Medicare.

Reference

1. Shi KS, Ji X, Yabroff R, Han X. Spillover effects of Medicaid expansion on insurance coverage among low-income older individuals newly diagnosed with cancer. JCO Oncol Pract. 2024;20(suppl 10):Abstract 168. https://ascopubs.org/doi/10.1200/OP.2024.20.10_suppl.168