Study: State Medicaid Income Limits Impact Cancer Survival Rates


Rates of death among patients with breast cancer due to any cause were 31% higher in states with Medicaid income eligibility limits no greater than 50% of the federal poverty level.

Patients with newly diagnosed cancer live longer in states with higher Medicaid income limits, according to new study results to be presented at the American Society of Clinical Oncology (ASCO) 2021 Annual Meeting.

Income eligibility limits for Medicaid can vary significantly state-by-state for non-elderly populations, according to the researchers. The team examined the association between state Medicaid eligibility limits and long-term survival of patients newly diagnosed with cancer.

In addition to finding that states with higher Medicaid income eligibility limits had better long-term survival rates, the investigators found that this association was consistent across a variety of cancers and for patients with both early- and late-stage disease and diagnosis. According to the press release, 39 states, including the District of Columbia, currently have expanded Medicaid income limits.

“To date, little has been known about the effects of Medicaid income eligibility limits on cancer outcomes,” said lead author Jingxuan Zhao, MPH, an associate scientist at ASCO, in a press release. “Our research provides strong evidence that state expansion of Medicaid is associated with better long-term survival among newly diagnosed cancer patients.”

Using the National Cancer Database, the investigators identified nearly 1.5 million adults diagnosed with 1 of 17 common cancers between 2010 and 2013, prior to the implementation of Medicaid expansion under the Affordable Care Act. Survival time was measured from diagnosis to December 31, 2017, for up to 8 years of follow-up.

States were categorized by Medicaid income eligibility limits as a percentage of the federal poverty level (FPL): 50% of the FPL or less; between 51% and 137% of the FPL; and 138% of the FPL or greater.

Among patients diagnosed with early-stage breast cancer between 2010 and 2013 and followed through 2017, the rate of deaths due to any cause was 31% higher in states with Medicaid income eligibility limits no greater than 50% the FPL. The rate of deaths was 17% higher in states with limits between 51% and 137% of the FPL, compared with similar patients in the 11 states with Medicaid income eligibility limits of 138% FPL or greater prior to 2014.

“This study shows that states with expanded Medicaid income eligibility limits have improved cancer survival rates, consistent across cancer type and stage,” said ASCO President Lori J. Pierce, MD, FASTRO, FASCO, in the press release. “Health insurance coverage is associated with improved access to cancer prevention, diagnosis, and treatment, allowing us better opportunities to provide the right care to the right patient at the right time.”

With this knowledge in mind, the investigators said they plan to use the same database to explore the association of Medicaid income eligibility limits and access to cancer treatment among newly diagnosed patients with cancer. They also plan to use nationally representative survey data to explore the links between Medicaid income eligibility limits and access to health care and affordability among individuals who have recovered from cancer.

Additional analyses could include the association between Medicaid income eligibility limits and other outcomes, such as stage at cancer diagnosis and receipt of cancer treatment, and whether cancer outcomes differ by race or ethnicity, area-level poverty, and Medicaid Savings Account.


Patients With Newly Diagnosed Cancer Live Longer in States With Higher Medicaid Income Limits [news release]. American Society of Clinical Oncology; May 19, 2021. Accessed May 26, 2021.

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