Increased Medicaid Payments for Office Visits Results in More Screening for Cancer

Medicaid patients in states that pay more for office visits had an increased likelihood of being screened for cancer, according to results of a study published in CANCER, a peer-reviewed journal of the American Cancer Society.

Michael Halpern, MD, PhD, MPH, of RTI International, and his colleagues analyzed 2007 Medicaid data from 46 states and Washington DC to determine whether state Medicaid eligibility and reimbursement policies affect screening rates for breast, cervical, and colorectal cancer among Medicaid beneficiaries.

The screening tests examined were for colonoscopies (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 1.06-1.08), fecal occult blood tests (OR, 1.09; 95% CI, 1.08-1.10), Pap smears (OR, 1.02; 95% CI, 1.02-1.03), and mammographies (OR, 1.02; 95% CI, 1.02-1.03).

They found that increased reimbursement for office visits positively affected the odds of receiving screening tests, but increases in the amount paid for screening tests themselves had mixed associations (both positive and negative). For example, a 20% increase in office visit reimbursement was associated with increases in the odds of screening ranging from 2.2% for mammography to 8.7% for fecal occult blood test.

In contrast, a 20% increase in screening test reimbursement (based on the national median reimbursement) was associated with a 1.6% increase in the odds of receiving a colonoscopy and an 0.8% decrease in the odds of receiving a Pap test.

"Our study was able to compare differences in cancer screening for Medicaid beneficiaries in almost all states, providing a broad, national picture of the effects of state-level Medicaid policies on receipt of these critical medical care services among a large group of underserved individuals," said Halpern in a news release.

Although Medicaid is a joint state-federal government health insurance program, each state sets the policies for its own Medicaid program within requirements set by the federal government. This includes setting how much providers are paid for health care services and who is allowed to enroll in Medicaid.

The authors wrote that “increasing reimbursement levels for screening tests may expand the supply of facilities (eg, laboratories, imaging facilities) providing services for Medicaid beneficiaries, but increasing payments for office visits may increase access to and/or the supply of providers ordering the tests.” In addition, raising Medicaid payments for office visits may facilitate access to primary care among beneficiaries, increasing the likelihood of receiving cancer screening tests, noted the researchers.

"Our findings can help state health care decision makers and policy leaders to develop new Medicaid policies that aid low income individuals in receiving recommended cancer screenings," said Halpern.