The Impact of Medicaid Expansion on Insurance Coverage and Metastatic Disease at Diagnosis for Racial and Ethnic...

Improved access to health care following the Affordable Care Act's Medicaid expansion may affect prostate cancer (PCa) disease course. We hypothesized that Medicaid expansion states (ESs) experienced greater Medicaid coverage gains and lower proportions of metastatic disease at the time of detection.

We analyzed 1.02 million patients aged 40 to 64 years diagnosed with PCa from 2004 to 2022 using the National Cancer Database. We generated descriptive statistics on demographic variables and divided patients into groups using diagnosis date (pre expansion and post expansion) and state expansion status (ES and nonexpansion state [NES]). Multivariate logistic regression analysis was performed to determine the impact of expansion status and demographics on Medicaid enrollment and metastatic disease at diagnosis.

In pre-expansion years, the percentage of Medicaid patients in ESs and NESs was 3.5% vs 2.5%, respectively. After expansion, Medicaid patient percentage rose in ESs (9.5%, +6.0%) and NESs (4.4%, +1.9%). Pre expansion, the odds of being enrolled in Medicaid was 3.01 times higher for Black patients than White patients, which declined to 2.62 after expansion. The odds of being enrolled in Medicaid for those in ESs vs NESs rose from 1.80 to 2.94 after expansion. The odds ratio (OR) of presenting with metastatic disease among Medicaid patients in NESs (OR 4.11) was 1.37 times higher (95% CI 1.29-1.45, P < .0001) than Medicaid patients in ESs (OR 3.00).

Medicaid expansion provided coverage gains through Medicaid for PCa patients, who also had lower odds of metastatic disease at diagnosis.