Am J Manag Care. 2026 Jul 1;32(7):e234-e241. doi: 10.37765/ajmc.2026.89988.
ABSTRACT
OBJECTIVES: The burden of a new cancer diagnosis on state Medicaid programs is not well understood. Our study aimed to (1) quantify Medicaid program spending, use of health care services, and enrollment patterns among Medicaid beneficiaries newly diagnosed with cancer; and (2) assess how spending and health care use differ between a new metastatic and a new nonmetastatic cancer diagnosis.
STUDY DESIGN: Cross-sectional study.
METHODS: This study used Transformed Medicaid Statistical Information System Analytic Files (2016-2019) to identify Medicaid beneficiaries 50 years and older who were newly diagnosed with cancer in 2017 and 2018. We provide descriptive evidence about their use of health care resources and used linked Medicare-Medicaid claims to follow enrollment patterns among dual-eligible beneficiaries. We also used generalized estimating equations to compare Medicaid program spending among those diagnosed with a new metastatic vs nonmetastatic cancer. Study measures were differences in total Medicaid spending, hospitalizations and emergency department visits per year, and Medicaid enrollment status at the end of the study (ie, continuously enrolled, disenrolled, or died) by metastatic status.
RESULTS: We identified 291,014 new cancer diagnoses among Medicaid beneficiaries 50 years and older (18.8% metastatic vs 81.2% nonmetastatic). A metastatic cancer diagnosis was associated with higher hospitalizations, emergency department use, and spending compared with a nonmetastatic cancer diagnosis.
CONCLUSIONS: Our results quantify the cost and health care resource utilization burden borne by state Medicaid programs following a new cancer diagnosis. These findings can inform policy makers about the budgetary considerations associated with investing in reducing late-stage cancer diagnoses, such as through early detection and increased access to care.
PMID:42640261 | DOI:10.37765/ajmc.2026.89988
