title: Impact of state-specific Medicaid reimbursement and eligibility policies on receipt of cancer screening.
abstract: BACKGROUND
  Although state Medicaid programs cover cancer screening, Medicaid beneficiaries are less likely to be screened for cancer and are more likely to present with tumors of an advanced stage than are those with other insurance. The current study was performed to determine whether state Medicaid eligibility and reimbursement policies affect the receipt of breast, cervical, and colon cancer screening among Medicaid beneficiaries.
  
  
  METHODS
  Cross-sectional regression analyses of 2007 Medicaid data from 46 states and the District of Columbia were performed to examine associations between state-specific Medicaid reimbursement/eligibility policies and receipt of cancer screening. The study sample included individuals aged 21 years to 64 years who were enrolled in fee-for-service Medicaid for at least 4 months. Subsamples eligible for each screening test were: Papanicolaou test among 2,136,511 patients, mammography among 792,470 patients, colonoscopy among 769,729 patients, and fecal occult blood test among 753,868 patients. State-specific Medicaid variables included median screening test reimbursement, income/financial asset eligibility requirements, physician copayments, and frequency of eligibility renewal.
  
  
  RESULTS
  Increases in screening test reimbursement demonstrated mixed associations (positive and negative) with the likelihood of receiving screening tests among Medicaid beneficiaries. In contrast, increased reimbursements for office visits were found to be positively associated with the odds of receiving all screening tests examined, including colonoscopy (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 1.06-1.08), fecal occult blood test (OR, 1.09; 95% CI, 1.08-1.10), Papanicolaou test (OR, 1.02; 95% CI, 1.02-1.03), and mammography (OR, 1.02; 95% CI, 1.02-1.03). Effects of other state-specific Medicaid policies varied across the screening tests examined.
  
  
  CONCLUSIONS
  Increased reimbursement for office visits was consistently associated with an increased likelihood of being screened for cancer, and may be an important policy tool for increasing screening among this vulnerable population.
authors.affiliation: RTI International, Washington, DC.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Halpern
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Romaire
authors.forename: Susan G
authors.initials: SG
authors.lastname: Haber
authors.forename: Florence K
authors.initials: FK
authors.lastname: Tangka
authors.forename: Susan A
authors.initials: SA
authors.lastname: Sabatino
authors.forename: David H
authors.initials: DH
authors.lastname: Howard
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000191:economics / Q000517:prevention & control; D003110:Colonic Neoplasms / Q000191:economics / Q000517:prevention & control; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000191:economics*; D004608:Eligibility Determination / Q000191:economics / Q000331:legislation & jurisprudence; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data; D008403:Mass Screening / Q000191:economics*; D008484:Medicaid / Q000331:legislation & jurisprudence; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000208:ethnology / Q000517:prevention & control*; D009780:Occult Blood; D016017:Odds Ratio; D009819:Office Visits / Q000191:economics; D065006:Papanicolaou Test / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000517:prevention & control; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000208:ethnology / Q000706:statistics & numerical data
keywords: Medicaid; Papanicolaou test; access to health care; cancer screening; colonoscopy; health care disparities; health insurance reimbursement; mammography