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Researcher: Jingxuan Zhao, MPH
Institution: American Cancer Society
Area of Focus: Surveillance & Health Equity Science
“We consistently found a link between lower Medicaid eligibility limits and worse survival after a cancer diagnosis. And that was true whether the cancer was found at an early or late stage. Our findings show that Medicaid plays an important role in improving health outcomes for people diagnosed with cancer that could be explained for multiple reasons.
“Having health insurance may improve access to timely, may make receiving guideline-based treatment easier to receive and complete, and may improve access to specialized healthcare in survivorship, psychosocial care, and end-of-life care and hospice care.”
The Challenge: The Medicaid program provides health insurance coverage in the United States for some people with limited incomes, families and children, pregnant women, the elderly, and people with disabilities. It’s jointly funded by federal and state governments. But each state has the ability to set the maximum amount of money a family can make a year and still qualify for Medicaid. This maximum is often referred to as the Medicaid income eligibility limit.
Since 2014, the Affordable Care Act (ACA) provided financial incentives to states to increase the number of people who would be eligible to receive Medicaid. But not all states have accepted the offer and expanded Medicaid.
States that only allow people who have very low yearly incomes to be able to receive Medicaid benefits may keep many people who live in that state from having health insurance. And research has shown that people who don’t have health insurance often do not receive cancer care. They’re less likely to get screened, be diagnosed with cancer when it’s at an early stage and less complicated to treat, and to receive guideline-based cancer treatment and survivorship care.
Little research has been done to examine how Medicaid qualification based on a maximum income limit before the ACA affected cancer outcomes. Learning more could inform policies related to income maximums for Medicaid eligibility.
The Research: American Cancer Society (ACS) researcher Jingxuan Zhao, MPH, and some of her colleagues in Surveillance & Health Equity Science recently published their study about how state historic income eligibility limits for Medicaid affect long-term survival among people newly diagnosed with cancer.
They used data from the National Cancer Database to identify people who were:
About 1.5 million individuals newly diagnosed with cancer were included in the study. Survival time was measured from the diagnosis date to the end of the study for up to 8 years of follow-up. And the researchers categorized states’ Medicaid income eligibility limits as: 50% FPL or less, 51% to 137% FPL, and 138% FPL or more.
They found that people with cancer living in states with lower Medicaid income eligibility limits did not live as long after a diagnosis for most types of cancer (both early and late stage), compared to those living in states with higher Medicaid income eligibility limits, set at 138% FPL or above.
The researchers note that future studies that focus on the link between Medicaid income eligibility limits and access to specific cancer treatments and cancer survivorship care are needed.
Why Does It Matter? Results of this nationwide study suggest that national or state policies, or both, that raise the income eligibility limits for Medicaid may improve survival after a cancer diagnosis in the US.
FPL stands for Federal Poverty Line. It’s published each year by the US Department of Health and Human Services and used to set eligibility limits for several programs and benefits. These programs include Medicaid, Children’s Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), Supplemental Nutrition Program for Women, Infants, and Children (WIC), and other “welfare” programs.
138% FPL is the maximum yearly income the ACA supports for people to qualify for Medicaid. In 2022 for example, the FPL for a family of 3 is $23,030. The ACA provides financial incentives that allow parents in a family of 3 to have a yearly income up to 138% of the FPL, which is $31,781 [$23,030 + (38% of $23,030)], and still qualify for Medicaid. 37 states have 138% FPL as their Medicaid income eligibility limit.
But states can set their own income limits for Medicaid eligibility, and they can be below, at, or above the FPL.
At 221% of the FPL, Washington D.C. has the most generous Medicaid income eligibility limit for a family of 3 in 2022. That’s equal to $50,896 a year. Connecticut’s limit is 160% FPL, and it’s the only other state to have a high income limit, above 138% FPL.
At 16% of the FPL, Texas has the least generous Medicaid income eligibility limit for a family of 3 in 2022. That’s $3,684 a year. That means that families of 3 who make more $3,684 a year, even if they still fall below the poverty line, do not qualify for health insurance through Medicaid.