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Medicaid expansion under the Affordable Care Act was intended to increase health insurance coverage for adults under 65. New research suggests its cancer benefits also extended to older adults.
A study led by American Cancer Society researchers found Medicaid expansion was associated with increased Medicaid coverage, earlier-stage cancer diagnoses, and improved survival among adults age 65 and older in low-income communities.
The findings, published in JNCCN—Journal of the National Comprehensive Cancer Network, are notable because most adults in this age group already qualify for Medicare. But Medicare does not necessarily remove the financial and logistical barriers that can complicate cancer care.
“Most research on Medicaid expansion has focused on younger adults, but many older adults with cancer still face financial barriers to care,” said Kewei Sylvia Shi, MPH, associate scientist, health services research at the American Cancer Society, and lead author of the study. “Our findings suggest Medicaid expansion is helping improve access to coverage and cancer care for low-income older adults, even though they were not the primary population targeted by the policy.”
Looking at More Than 1.46 Million Cancer Patients
Researchers analyzed National Cancer Database data from more than 1.46 million adults age 65 and older living in low-income communities who were newly diagnosed with cancer between 2010 and 2021.
They compared outcomes before and after Medicaid expansion among patients living in expansion and non-expansion states.
Although Medicare provides health coverage for most Americans beginning at age 65, some older adults also qualify for Medicaid. For these patients, Medicaid can help cover premiums, out-of-pocket expenses, transportation, long-term care, and other services Medicare does not fully cover.
Earlier Diagnoses and Better Survival
Patients in Medicaid expansion states experienced greater increases in coverage and smaller declines in early-stage cancer diagnoses than patients in non-expansion states, according to the study.
Two-year survival following a cancer diagnosis also improved more in expansion states.
The Medicaid expansion-associated improvements in earlier-stage diagnosis were particularly notable for lung cancer and head and neck cancer. Survival improvements were particularly notable among patients with stage IV cancers and those with lung, kidney, and bladder cancers.
The benefits were strongest among several groups that often face greater barriers to care, including non-Hispanic Black patients, people living in non-metropolitan communities, patients with multiple chronic conditions, and those diagnosed with advanced-stage cancers.
“While the improvements observed at the individual level were modest, they could translate into meaningful benefits across the large population of older adults diagnosed with cancer each year,” Shi said. “The findings highlight how policies that expand access to health insurance coverage may help reduce barriers to care and improve outcomes among vulnerable older adults with cancer.”
Why This Matters for Nurses
For nurses, the findings highlight an important reality of caring for older adults with cancer: Medicare does not necessarily address every need that can affect a patient’s ability to access and continue care.
Patients may still face out-of-pocket costs, transportation challenges, long-term care needs, and other barriers during diagnosis and treatment. For those who also qualify for Medicaid, the additional coverage can help address some of those gaps.
These issues can surface across oncology, primary care, case management, care coordination, and community health, particularly when nurses care for older adults with complex medical and financial needs.
For older adults living in low-income communities, the study suggests expanded Medicaid coverage may have implications beyond insurance status, including cancer stage at diagnosis and survival after diagnosis.
