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The impact of continuous Medicaid enrollment on diagnosis, treatment, and survival in six surgical cancers.

ABSTRACT: To examine the effect of Medicaid enrollment on the diagnosis, treatment, and survival of six surgically relevant cancers among poor and underserved Californians.California Cancer Registry (CCR), California's Patient Discharge Database (PDD), and state Medicaid enrollment files between 2002 and 2008.We linked clinical and administrative records to differentiate patients continuously enrolled in Medicaid from those receiving coverage at the time of their cancer diagnosis. We developed multivariate logistic regression models to predict death within 1 year for each cancer after controlling for sociodemographic and clinical variables.All incident cases of six cancers (colon, esophageal, lung, pancreas, stomach, and ovarian) were identified from CCR. CCR records were linked to hospitalizations (PDD) and monthly Medicaid enrollment.Continuous enrollment in Medicaid for at least 6 months prior to diagnosis improves survival in three surgically relevant cancers. Discontinuous Medicaid patients have higher stage tumors, undergo fewer definitive operations, and are more likely to die even after risk adjustment.Expansion of continuous insurance coverage under the Affordable Care Act is likely to improve both access and clinical outcomes for cancer patients in California.

SUBMITTER: Dawes AJ

PROVIDER: S-EPMC4254125 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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The impact of continuous Medicaid enrollment on diagnosis, treatment, and survival in six surgical cancers.

Dawes Aaron J AJ Louie Rachel R Nguyen David K DK Maggard-Gibbons Melinda M Parikh Punam P Ettner Susan L SL Ko Clifford Y CY Zingmond David S DS

Health services research 20140926 6

<h4>Objective</h4>To examine the effect of Medicaid enrollment on the diagnosis, treatment, and survival of six surgically relevant cancers among poor and underserved Californians.<h4>Data sources</h4>California Cancer Registry (CCR), California's Patient Discharge Database (PDD), and state Medicaid enrollment files between 2002 and 2008.<h4>Study design</h4>We linked clinical and administrative records to differentiate patients continuously enrolled in Medicaid from those receiving coverage at ...[more]

PMID: 25256223

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Project description:ObjectiveTo estimate the incremental associations between the implementation of expanded Medicaid eligibility and prerelease Medicaid enrollment assistance on Medicaid enrollment for recently incarcerated adults.Data sources/study settingData include person-level merged, longitudinal data from the Wisconsin Department of Corrections and the Wisconsin Medicaid program from 2013 to 2015.Study designWe use an interrupted time series design to estimate the association between each of two natural experiments and Medicaid enrollment for recently incarcerated adults. First, in April 2014 the Wisconsin Medicaid program expanded eligibility to include all adults with income at or below 100% of the federal poverty level. Second, in January 2015, the Wisconsin Department of Corrections implemented prerelease Medicaid enrollment assistance at all state correctional facilities.Data collection/extraction methodsWe collected Medicaid enrollment, and state prison administrative and risk assessment data for all nonelderly adults incarcerated by the state who were released between January 2013 and December 2015. The full sample includes 24 235 individuals. Adults with a history of substance use comprise our secondary sample. This sample includes 12 877 individuals. The primary study outcome is Medicaid enrollment within the month of release.Principal findingsMedicaid enrollment in the month of release from state prison grew from 8 percent of adults at baseline to 36 percent after the eligibility expansion (P-value < .01) and to 61 percent (P-value < .01) after the introduction of enrollment assistance. Results were similar for adults with a history of substance use. Black adults were 3.5 percentage points more likely to be enrolled in Medicaid in the month of release than White adults (P-value < .01).ConclusionsMedicaid eligibility and prerelease enrollment assistance are associated with increased Medicaid enrollment upon release from prison. States should consider these two policies as potential tools for improving access to timely health care as individuals transition from prison to community.

Project description:Research objectiveTo explore whether expanded Medicaid helps mitigate the relationship between unemployment due to COVID and being uninsured. Unanticipated unemployment spells are generally associated with disruptions in health insurance coverage, which could also be the case for job losses during the COVID-19 pandemic. Expanded access to Medicaid may insulate some households from long uninsurance gaps due to job loss.Data sourcePhase 1 of the Census Bureau's Experimental Household Pulse Survey covering April 23, 2020-July 21, 2020.Study designWe compare differences in health insurance coverage source and status linked to recent lob losses attributable to the COVID-19 pandemic in states that expanded Medicaid against states that did not expand Medicaid.Data collection/extraction methodsOur analytical dataset was limited to 733,181 non-elderly adults aged 20-64.Principal findingsTwenty-six percent of our study sample experienced an income loss between March 13, 2020, and the time leading up to the survey-16% experienced job losses (e.g., layoff, furlough) due to the COVID-19 crisis, and 11% had other reasons they were not working. COVID-linked job losses were associated with a 20 (p < 0.01) percentage-point (PPT) lower likelihood of having employer-sponsored health insurance (ESI). Relative to persons in states that did not expand Medicaid, persons in Medicaid expansion states experiencing COVID-linked job losses were 9 PPT (p < 0.01) more likely to report having Medicaid and 7 PPT (p < 0.01) less likely to be uninsured. The largest increases in Medicaid enrollment were among people who, based on their 2019 incomes, would not have qualified for Medicaid previously.ConclusionsOur findings suggest that expanded Medicaid eligibility may allow households to stabilize health care needs and they should become detached from private health coverage due to job loss during the pandemic. Households negatively affected by the pandemic are using Medicaid to insure themselves against the potential health risks they would incur while being unemployed.

Dataset Information

The impact of continuous Medicaid enrollment on diagnosis, treatment, and survival in six surgical cancers.

Publications

The impact of continuous Medicaid enrollment on diagnosis, treatment, and survival in six surgical cancers.

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