Access to urologic cancer care for Medicaid-insured patients.

Abstract

The expansion of state Medicaid programs associated with the Affordable Care Act has led to significant increases in insurance coverage for economically vulnerable patients, however barriers to accessing cancer care still exist. To develop strategies to improve healthcare access, we characterized access to new urologic cancer care for patients with Medicaid insurance in the United States. Using a secret shopper approach, we contacted a representative sample of facilities designated for cancer care in United States. Trained volunteers posed as a family member seeking urologic cancer care using a simulated scenario of a parent with a new diagnosis of a localized kidney tumor. The primary study outcome was acceptance of Medicaid. In addition, we assessed facility characteristics associated with Medicaid acceptance relating to state Medicaid expansion status, Medicare reimbursement rates, and teaching hospital status using data from the Medicare & Medicaid Services Hospital General Information data file, the American Hospital Directory, and the American Medical Association of Colleges Organizational Characteristics Database. We sampled a total of 389 facilities, of which 14.4% did not accept new Medicaid patients. Medicaid acceptance was higher in facilities located in states that elected to expand Medicaid through the ACA vs. non-expansion states (90.1% vs. 77.4% respectively, P < 0.001). Facilities accepting patients with Medicaid were located in states with higher mean Medicaid-to-Medicare fee indexes (0.70 for Medicaid-accepting vs. 0.65 for non-accepting facilities, P < 0.001). In addition, Medicaid acceptance was higher in teaching hospitals vs. non-teaching facilities (93.8% vs. 83.4% P = 0.02), and medical school affiliated facilities (89.2% vs. 79.7% P = 0.01). We identified access disparities for patients with Medicaid insurance seeking urologic cancer care at centers. These findings highlight opportunities to improve the quality and timeliness of cancer care.