Medicaid expansion has improved access to palliative care for cancer patients

July 13, 2023 — Medicaid recipients with advanced-stage cancer may have greater access to palliative care in states that have adopted Medicaid expansion, according to a study published in Health Affairs.

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

The researchers noted that their sample may have underestimated the amount of palliative care patients received because some services were not included in the database. Also, the data was not as granular on some patient demographics.

The most common types of cancer in the sample were lung, colon and rectum, oral cavity and pharynx, non-Hodgkin’s lymphoma and pancreatic cancer. Of the patients studied, more than 439,100 patients were from expanding states and nearly 246,640 were from non-expanding states. Participants in non-expansion status were more likely to be non-Hispanic, low-income, non-metropolitan, and uninsured Black.

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

However, in both scenarios, the proportion of patients with advanced cancers who received palliative care increased over time. In 2010, 16.1% of advanced-stage cancer patients in sprawling states received palliative care, but by 2019, this share had increased to 21.0%. In non-booming states, the share of individuals receiving palliative care grew from 15.6% to 18.9% over the same nine-year period.

“The gap in the percentage receiving palliative care between expansion and non-expansion states widened after the implementation of Medicaid expansion began,” the researchers said.

Individuals who were younger, Hispanic, high-income, and had no comorbidities were less likely to receive palliative care. Rates of palliative care have increased among older (ages 55 to 64), non-Hispanic white, and non-metropolitan individuals.

The researchers concluded that palliative care treatment was unsatisfactory, despite the growth in prevalence over the years. Although studies recommend the early introduction of palliative care to improve patient experience and satisfaction, most patients have not received any palliative care. Only about one in five received palliative care.

However, the researchers found that the expansion of Medicaid has increased access to care among advanced-stage cancer patients. The study suggested that Medicaid beneficiaries may face fewer financial barriers to accessing palliative care due to Medicaid expansion. Additionally, they may have greater access to value-based care coverage for these services.

“The expansion of insurance coverage, and Medicaid coverage in particular, may be a promising policy lever to improve the use of palliative care,” the study said.

Medicaid expansion has been studied extensively for its impact on patient outcomes and states’ health care spending. Previous studies have explored the impact this policy could have on overall U.S. uninsured rates and on health care equity, evictions and housing security, death rates, and more.