Abstract A82: Medicaid disenrollment in Tennessee and disparities in stage at diagnosis and surgery for female breast cancer
Authors: Tarazi Wafa W. , Bradley Cathy J. , Bear Harry D. , Harless David W. , Sabik Lindsay M. 
Published: May 2016

Purpose: To assess the effects of Medicaid disenrollment on stage at diagnosis and delay in surgery for female breast cancer among nonelderly women.

Background: Although Medicaid expansions have received considerable attention in the literature, Medicaid contractions have received much less attention. Tennessee's Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults after implementing a new benefit policy in 2005. Despite the fact that this was the largest disenrollment in the history of Medicaid, little is known about the effects of this policy change on access to care and health outcomes. This is the first study, to our knowledge, to consider the effect of disenrollment on stage at diagnosis and delay in surgery for breast cancer.

Methods: We use 2002-2008 data from Tennessee Cancer Registry which collects data on newly diagnosed cases of malignant disease that occur to Tennessee residents from all hospitals, laboratories, facilities and healthcare practitioners. The sample used for this study consists of women aged 21 to 64 who were diagnosed with breast cancer and living in Tennessee during the period of study. We merge data on zip code median income with the Tennessee Cancer Registry data and estimate a difference-in-differences model. We calculate the changes in stage at diagnosis, more than 60-days delay in surgery, and more than 90-days delay in surgery for female breast cancer among women who were diagnosed with breast cancer and had surgery as the first-line treatment. The difference-in-differences model compares women who were living in low-income zip codes (and thus more likely to be subject to disenrollment) with women who lived in high-income zip codes before and after Tennessee's 2005 Medicaid disenrollment. We control for age, race/ethnicity, marital status, insurance coverage, and year fixed effects.

Results: Preliminary results suggest that nonelderly women who lived in low-income zip codes were 2.8 percentage points (p &lt; 0.1) more likely to be diagnosed with late stage (regional or distant) breast cancer, compared to women living in high-income zip codes, after Tennessee's Medicaid disenrollment. In addition, nonelderly women who lived in low-income zip codes were 1.9 percentage points (p &lt; 0.05) less likely to have more than 60-days delay in surgery than women living in high-income zip codes, after the disenrollment. Women who lived in low-income zip codes were also more likely to have more than 90-days delay in surgery, but this difference was not significant.

Conclusions: While many states are expanding Medicaid eligibility under the Affordable Care Act, there has been discussion among policymakers in some states to reduce eligibility once full federal funding expires. This study provides evidence on the potential impact of Medicaid disenrollment on delays in diagnosis and performing urgent surgeries to treat late stages of breast cancer among low-income women in states that may consider future changes to Medicaid eligibility.

Citation Format: Wafa W. Tarazi, Cathy J. Bradley, Harry D. Bear, David W. Harless, Lindsay M. Sabik. Medicaid disenrollment in Tennessee and disparities in stage at diagnosis and surgery for female breast cancer. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A82.