Xu Ji, PhD, MSPH
Research published in JCO Oncology Practice finds that continuity of Medicaid coverage increases the survival rates of children and adolescents with cancer. Led by researchers at Winship Cancer Institute of Emory University, the study provides critical insights into how gaps in Medicaid coverage can lead to significantly poorer survival for patients with pediatric cancer.
Utilizing data from Children’s Healthcare of Atlanta (CHOA), researchers analyzed Medicaid enrollment patterns for 1,800 children and teens diagnosed and treated with cancer at CHOA, discovering that fewer than half of those with Medicaid had continuous coverage before, during and after their cancer diagnosis. The findings also show that those who gained Medicaid only at or after diagnosis faced a comparatively higher risk of all-cause death and cancer-specific death.
Key findings from the study include:
- Among the cohort of pediatric patients, 71.8% had some form of Medicaid coverage during the 13-month period surrounding their cancer diagnosis. Of these, only 47.6% had continuous Medicaid coverage, while 36.3% gained Medicaid only at or after diagnosis.
- Patients who gained Medicaid coverage only at or after diagnosis had a significantly higher risk of five-year all-cause death (adjusted hazard ratio [aHR]=1.41) and cancer-specific death (aHR=1.46) compared to those with continuous Medicaid coverage.
- The results indicate that maintaining uninterrupted Medicaid coverage throughout the diagnostic and treatment phases is crucial for better pediatric cancer survival.
“Our findings carry significant implications for ongoing discussions about Medicaid programs,” says the study’s senior author Xu Ji, PhD, MSPH, member of the Cancer Prevention and Control research program at Winship Cancer Institute of Emory University and assistant professor in the Department of Pediatrics at Emory University School of Medicine. “Children, adolescents and young adults without continuous Medicaid coverage face an increased risk of poorer cancer survival outcomes; it is essential that we address these coverage gaps to improve long-term health.”
First author Xin Hu, PhD, MSPH, assistant professor in the Department of Radiation Oncology at Emory University School of Medicine, says, “Our results offer insights for institutional efforts to provide adequate and timely resource navigation for pediatric patients undergoing cancer treatment. Medicaid plays a crucial role in providing affordable health care and is the largest payer for children under 18. It is encouraging to see that over two-thirds of the oncology patient population at CHOA are covered by Medicaid at least for some time around diagnosis.”
Hu adds that it is not only the presence of coverage but also the continuity of coverage that impacts cancer outcomes. “Notably, many patients who recently gained Medicaid or experienced gaps in coverage were previously enrolled in private insurance. While Medicaid often offers more affordable care by eliminating cost-sharing, transitions between private insurance and Medicaid do not provide survival benefits similar to continuous Medicaid coverage. Coverage transfer may have led to delays in getting treatment,” she says. If this is the case, at the institutional level, future efforts by care teams including social workers to ensure seamless and timely coverage transitions could help to improve patient outcomes, according to Hu.
Ji and her colleagues also explored a subset of patients with blood cancers in a separate study that will be published in JNCI later this month. This research focuses on children, adolescents and young adults with leukemia and lymphoma, highlighting similar trends regarding the importance of insurance coverage continuity. Like the broader study, this research found that Medicaid coverage gaps contribute to inferior blood cancer outcomes, providing further evidence of the health impact of consistent access to care in these vulnerable populations.
Moving forward, Ji's team plans to expand their research to explore how insurance continuity affects long-term survivorship and post-treatment care in patients with pediatric cancer. “Ensuring seamless Medicaid coverage throughout and beyond treatment could be a vital step in improving survival and quality of life for these young patients,” says Ji.
The study was conducted with contributions from several other researchers from Winship’s Cancer Prevention and Control program including Sharon M. Castellino, MD, MSc; Joseph Lipscomb, PhD; and Ann C. Mertens, PhD. Their combined efforts have provided actionable insights into the role of health insurance continuity in pediatric cancer care.