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Impact of state-specific Medicaid policies on timely receipt of breast cancer surgery.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: Reports have demonstrated barriers in access to and quality of care for Medicaid enrollees, including enrollees with cancer. State-specific Medicaid eligibility policies and low reimbursements for medical care services provided to enrollees with cancer may hinder receipt of high-quality cancer treatment. This study examined how eligibility and reimbursement policies affect timely receipt of breast cancer surgery among Medicaid enrollees diagnosed with breast cancer. Methods: The study utilized 2006-2008 Medicaid data for all women 21-64 years of age diagnosed with breast cancer and enrolled in fee-for-service Medicaid for at least 4 months. We examined the association of state-specific Medicaid breast surgery reimbursements, Medicaid income eligibility requirements, and frequency of Medicaid eligibility renewal on time from diagnosis to receipt of breast cancer surgery. Analyses used multivariate logistic regressions controlling for correlation between beneficiaries within a state. Results: We identified 10,968 Medicaid enrollees with breast cancer. Lower reimbursements for breast cancer surgery were associated with greater delays for breast conserving surgery, mastectomy, and all breast cancer surgery combined. Shorter time periods for Medicaid eligibility renewal were also associated with greater surgery delays. Income eligibility thresholds did not affect delays. Black, Hispanic, and blind/disabled patients had greater delays, while older patients were less likely to experience delays. Conclusions: Low reimbursements were associated with less timely surgery for Medicaid enrollees with breast cancer. In addition, within the Medicaid population, disparities in timeliness of surgery based on patient race, age, and eligibility category were observed. With substantial expansion of Medicaid expected as part of the Affordable Care Act, state legislators and health policy makers need to consider how reimbursements affect receipt of high quality care and develop programs to address disparities within this vulnerable population.