Continuous Medicaid Coverage Associated With Lower Incidence of Stage IV Lymphoma Among Children and Young Adults

Continuous Medicaid coverage is associated with lower likelihood of late-stage disease among pediatric and young adult patients with lymphoma, according to a study published in Blood Advances.

“Steady access to Medicaid insurance helps ensure early recognition of symptoms, timely referrals to cancer specialists, quick diagnosis, prompt initiation of treatment, and continuous cancer care—all of which are essential for better survival, especially given that blood cancers often appear suddenly and lack routine screening options,” Xu Ji, PhD, MSPH, senior author of the study and assistant professor in the Department of Pediatrics at Emory University School of Medicine, told Blood Cancers Today.

Using the Surveillance, Epidemiology, and End Results (SEER)–Medicaid linked data resource, Dr. Ji and colleagues identified 3,524 patients aged 0 to 39 years with newly diagnosed lymphoma from 12 US states. Patients were categorized by Medicaid enrollment patterns; 37.8% had continuous Medicaid coverage (before and after diagnosis), 35.2% had newly acquired Medicaid coverage (at or shortly after diagnosis), and 27.0% had other Medicaid enrollment patterns.

Medicaid enrollment patterns also varied by patient sociodemographic characteristics. The percentage of patients with newly acquired Medicaid was higher for non-Hispanic White patients (39.1%) compared with non-Hispanic Black (32.5%) or Hispanic patients (30.4%), but the percentage of patients with continuous Medicaid was lower for non-Hispanic White patients (34.3%) compared with non-Hispanic Black (41.2%) or Hispanic patients (41.4%).

Patients with newly acquired Medicaid coverage had the highest incidence of stage IV lymphoma diagnosis (41.0%) compared with patients with other Medicaid enrollment patterns (29.5%) and continuous Medicaid coverage (25.8%). In an adjusted analysis, patients with newly acquired Medicaid coverage were 54% (95% CI, 8.5-19.2; P<0.001) more likely to be diagnosed with stage IV lymphoma, and patients with other Medicaid enrollment patterns were 18% (95% CI, 2.2-7.0; P<0.001) more likely to receive this diagnosis.

Dr. Ji noted that patients with blood cancers with continuous Medicaid coverage also had the lowest risk of death compared with patients with newly acquired Medicaid or other types of noncontinuous Medicaid coverage, according to another study published in the Journal of the National Cancer Institute.

“Together, our findings highlight the critical role of continuous Medicaid coverage in ensuring timely diagnosis, cancer treatment, and improved survival for young people facing serious illnesses such as blood cancers,” Dr. Ji explained.

In both studies, less than half of patients insured with Medicaid had continuous coverage. Dr. Ji highlighted several actionable strategies to improve access to continuous Medicaid coverage for pediatric and AYA patients with blood cancers. These include implementing 12- or 24-month continuous Medicaid eligibility for all children and AYAs to prevent coverage gaps, adopting Medicaid expansion in all states, streamlining administrative processes by accelerating new Medicaid application processing and simplifying eligibility renewal, and promoting targeted outreach and enrollment assistance for patients transitioning out of pediatric care.

“A growing body of research shows that Medicaid Expansion has been associated with insurance coverage gains, reduced delays in care, and survival benefits, especially benefiting young adults,” Dr. Ji explained.