More cancer patients have been receiving palliative care since the Affordable Care Act expanded Medicaid.
About 18.9% of eligible patients received palliative care in states that expanded Medicaid, up from 17% before the ACA provisions took effect on Jan. 1, 2014, according to American Cancer Society research recently published in Health Affairs. Among non-expansion states, utilization increased from 15.7% to 16.7%.
The biggest impact was seen among patients with advanced colon, pancreatic, lung, oral cavity and pharynx cancers, as well as non-Hodgkin lymphoma, researchers found.
“Our findings are encouraging, especially with growing evidence of the important benefits of palliative care for patients with cancer,” said Dr. Xuesong Han, lead author of the study and scientific director of health services research at the American Cancer Society, in a statement. “It’s imperative to know how to target ways to increase access to these services, as use, overall, still remains low in the U.S.”
The availability of palliative care can vary based on where a patient lives, the study indicated.
To date, 39 states and the District of Columbia have adopted and implemented the ACA’s Medicaid expansion, and 10 have not, according to data from the Kaiser Family Foundation. One state, North Carolina, has adopted the expansion but has not yet implemented it.
The ACS team applied data from the National Cancer Database, a national hospital-based cancer registry sponsored by ACS in collaboration with the American College of Surgeons. The study included patients between the ages of 18 to 64 who were newly diagnosed with stage 4 cancers between 2010 and 2019.
As of 2014, the ACA expanded Medicaid coverage to all adults whose annual income reaches 138% of the federal poverty level, which in 2023 is $20,120 per individual, according to Kaiser. It also offered states a federal matching rate for populations receiving Medicaid coverage through the expansion.
A number of states have been exploring Medicaid as a vehicle for palliative care in a drive to reduce costs and improve patient outcomes.
Legislation has appeared in about 15 states that would direct state Medicaid agencies to research the feasibility of implementing expanded coverage for community-based palliative care. A few states — California, Colorado, Hawaii, Maine and Oregon — have already established such benefits.
Earlier this year, New Jersey legislators began considering a bill that would create a similar benefit.
“These study results suggest that the expansion of Medicaid coverage may increase palliative care use,” Han said of the ACS research. “They also point to a potentially widening geographic disparity in receipt of guideline-recommended palliative care between states with different health policies regarding income-based Medicaid eligibility requirements.”