Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies

Abstract

Background Colorectal cancer (CRC) screening is underutilized by Medicaid enrollees and the uninsured. Multiple national and state policies were enacted from 2010 to 2014 to increase access to Medicaid and to promote CRC screening among Medicaid enrollees. We aimed to determine the impact of these policies on screening initiation among newly enrolled Oregon Medicaid beneficiaries age-eligible for CRC screening. Methods We identified national and state policies affecting Medicaid coverage and preventive services in Oregon during 2010–2014. We used Oregon Medicaid claims data from 2010 to 2015 to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening (a prevention milestone, and an age at which guideline-concordant screening can be assessed within a single year) during each year from 2010 to 2014. We calculated risk ratios to assess whether first year of Medicaid enrollment and/or year turned 50 was associated with CRC screening initiation. Results We identified 14,576 Oregon Medicaid enrollees who turned 50 during 2010–2014; 2429 (17%) completed CRC screening within 12 months after turning 50. Individuals newly enrolled in Medicaid in 2013 or 2014 were 1.58 and 1.31 times more likely, respectively, to initiate CRC screening than those enrolled by 2010. A primary care visit in the calendar year, having one or more chronic conditions, and being Hispanic was also associated with CRC screening initiation . Discussion The increased uptake of CRC screening in 2013 and 2014 is associated with the timing of policies such as Medicaid expansion, enhanced federal matching for preventive services offered to Medicaid enrollees without cost sharing, and formation of Medicaid accountable care organizations, which included CRC screening as an incentivized quality metric. Electronic supplementary material The online version of this article (10.1186/s12913-019-4113-2) contains supplementary material, which is available to authorized users.

Cancer genetic testing in marginalized groups during an era of evolving healthcare reform

“…Zerhouni et al found that unlike African Americans, Latinos did not show a statistically significant increase in CRC screening in expansion states, suggesting additional access obstacles [ 49 ]. On the other hand, Latino Medicaid enrollees in Oregon, where Medicaid expansion was enacted in 2013, displayed relatively high CRC screening rates (screening risk ratio 1.16 compared to whites) for the 2010–2014 period [ 50 ]. Possible contributors were a statewide public health campaign to promote CRC screening and the use of community health workers.…”

Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research

“…Coverage disruption was not statistically significantly associated with receipt of screening in 1 study with a relatively small sample (n ¼ 333) that included adults older than age 65 years (who are generally age-eligible for continuous Medicare coverage) (30). Associations between coverage disruptions and colorectal cancer screening (eg, fecal occult blood test, flexible sigmoidoscopy, or colonoscopy) in men and women were null (27,30,38). Two of the 4 studies did not include colonoscopy (27,38), currently the most common colorectal cancer screening modality.…”

“…For the studies evaluating cancer prevention and screening, details of study populations, settings, measures of coverage disruptions and outcomes, comparison groups, and key findings are listed in Table 2. One study evaluated associations between coverage disruptions and HPV vaccination in adolescent girls (39), and 8 studies examined associations between disruptions and cancer screening in age-eligible adults (27)(28)(29)(30)(31)(32)37,38). Prevalence of coverage disruptions ranged from 4.3% to 32.8% in samples of adults without a cancer history and age-eligible for cancer screening in studies that reported this information (27,30).…”

“…Associations between coverage disruptions and colorectal cancer screening (eg, fecal occult blood test, flexible sigmoidoscopy, or colonoscopy) in men and women were null (27,30,38). Two of the 4 studies did not include colonoscopy (27,38), currently the most common colorectal cancer screening modality.…”

Mailed fecal immunochemical test outreach for colorectal cancer screening: Summary of a Centers for Disease Control and Prevention–sponsored Summit

“…Some states, including Oregon and Kentucky, have adopted incentives for Medicaid health plans to meet established performance and improvement targets. 62,63 Successfully sustained mailed FIT programs should use an organized, well-defined, and well-documented screening approach. Organized screening has explicit policies and standard workflows for how the screening should be performed and identifying the target population.…”