title: Access to the Indian health service care system is not associated with early enrollment in medicaid for American Indian and Alaska Natives with cancer.
abstract: BACKGROUND
  For uninsured American Indians and Alaskan Natives (AIAN) diagnosed with cancer, prompt enrollment in Medicaid may speed access to treatment and improve survival. We hypothesized that AIANs who were eligible for the Indian Health Service Care System (IHSCS) at cancer diagnosis may be enrolled in Medicaid sooner than other AIANs.
  
  
  METHODS
  Using Washington, Oregon, and California State Cancer Registries, we identified AIANs with a primary diagnosis of lung, breast, colorectal, cervical, ovarian, stomach, or prostate cancer between 2001 and 2007. Among AIANs enrolled in Medicaid within 365 days of a cancer diagnosis, we linked cancer registry records with Medicaid enrollment data and used a multivariate logistic regression model to compare the odds of delayed Medicaid enrollment between those with (n = 223) and without (n = 177) IHSCS eligibility.
  
  
  RESULTS
  Among AIANs who enrolled in Medicaid during the year following their cancer diagnosis, approximately 32% enrolled >1 month following diagnosis. Comparing those without IHSCS eligibility to those with IHSCS eligibility, the adjusted odds ratio (OR) for moderately late Medicaid enrollment (between 1 and 6 months after diagnosis) relative to early Medicaid enrollment (≤1 month after diagnosis) was 1.10 [95% confidence interval (CI), 0.62-1.95] and for very late Medicaid enrollment (>6 months to 12 months after diagnosis), OR was 1.14 (CI, 0.54-2.43).
  
  
  CONCLUSIONS
  IHSCS eligibility at the time of diagnosis does not seem to facilitate early Medicaid enrollment.
  
  
  CONCLUSIONS
  Because cancer survival rates in AIANs are among the lowest of any racial group, additional research is needed to identify factors that improve access to care in AIANs.
authors.affiliation: Authors' Affiliations: Fred Hutchinson Cancer Research Center, Seattle, Washington; Amgen, Inc., Thousand Oaks; California Rural Indian Health Board, Inc., Sacramento, California; and Northwest Portland Area Indian Health Board, Portland, Oregon.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Burnett-Hartman
authors.forename: Mark E
authors.initials: ME
authors.lastname: Bensink
authors.forename: Kristin
authors.initials: K
authors.lastname: Berry
authors.forename: David G
authors.initials: DG
authors.lastname: Mummy
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
authors.forename: Carol
authors.initials: C
authors.lastname: Korenbrot
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States; D016549:United States Indian Health Service / Q000706:statistics & numerical data*; D055815:Young Adult