Screening and Diagnosis Gaps

The new ASCO policy statement calls for Medicaid expansion to all 50 states and the closure of “critical coverage gaps” to improve access to cancer screening and prevention services, and to remove barriers to care for Medicaid recipients who are diagnosed with cancer.

Expanding cancer screening and doing away with copays for screening services are critical for early detection and treatment, ASCO officials said. Patients on Medicaid are twice as likely as privately insured patients to be diagnosed with cancer after their tumors have reached advanced stages, when treatment is less effective, Drs. Polite and Yu noted. Medicaid patients are also three times more likely to be diagnosed with lung cancer at an advanced stage.

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“Cancer screening should be available to every American,” Dr. Polite said.

Cost of Oral Cancer Drugs

Oral anticancer agents are increasingly important in clinical oncology, but higher cost-sharing requirements for orals under Medicaid “create significant financial barriers,” the report notes. “Some Medicaid patients pay co-payments of up to 20% of the cost of oral cancer drugs, which have become the mainstay of cancer care.”

Clinical Trials

The Affordable Care Act also mandates coverage of routine patient costs associated with participation in clinical trials, but the law’s wording did not specifically include Medicaid patients, Dr. Polite said. That contributes to racial disparities in clinical trial enrollment and “greatly impedes our ability to learn about potentially important differences” in different patient populations’ responses and toxicities, he said.

The ASCO policy statement therefore recommends legislation to grant Medicaid enrollees equal access to clinical trials. The new report also recommends that states be required to allow Medicaid patients to travel out of state for cancer care, Dr. Polite said.


Medicaid reimbursement rates for cancer services are compounding these problems, Dr. Polite added.

“Many physicians are unable to accept Medicaid payment” because they are being “squeezed” by relatively low reimbursement rates in an increasingly competitive environment. “This is especially problematic for patients with cancer because delays in treatment can lead to life-threatening complications,” he explained.

“No patient should be forced to accept anything less than the best possible care,” said National Coalition for Cancer Survivorship Chief Executive Officer Shelley Fuld Nasso.

RELATED: Cancer Care Worse with Medicaid, No Insurance

“Expanding Medicaid is a badly needed step, but improving the quality of the care it delivers to patients is just as important. We commend ASCO’s leadership in addressing changes needed to better serve individuals with limited financial resources.”      

Reform proponents “have a long road ahead,” Dr. Polite said. “But are committed to turning these recommendations into reality for our patients.”


  1. Polite BN, Griggs JJ, Moy B, et al. American Society of Clinical Oncology policy statement on Medicaid reform. Journal of Clinical Oncology. 2014 [Epub ahead of print]. doi: 10.1200/JCO.2014.56.3452