Over 1 Million Cancer Screenings at Risk With Recent Medicaid Changes

Tightened Medicaid eligibility rules under the 2025 Budget Reconciliation Bill could result in more than 1 million missed cancer screenings within 2 years and over 150 avoidable cancer deaths, new findings suggested.

“Clinicians should be genuinely concerned,” corresponding author Adrian Diaz, MD, MPH, a surgical oncology fellow at the University of Chicago, Chicago, told Medscape Medical News. “These projections suggest that Medicaid eligibility restrictions are likely to translate into delayed diagnoses, more advanced disease at presentation, and worse outcomes.”

The new law, which significantly reduces federal Medicaid funding, introduces mandatory work or community-engagement requirements for working-age adults as well as more frequent recertification starting in 2027.

In the study, a Research Letter published online on January 8 in JAMA Oncology, Diaz and Sarah Shubeck, MD, also from the University of Chicago, drew on data from Arkansas to model how these 2025 federal Medicaid eligibility restrictions could lead to loss of Medicaid coverage and consequently missed cancer screenings, especially in states that expanded Medicaid.

Diaz and Shubeck then paired coverage losses with state-level self-reported screening prevalences and estimated incident breast, colorectal, and lung cancers using 2-year risks.

In the first 2 years after implementation, the researchers predicted that 7.5 million adults (range, 5.0-10.8 million) will lose Medicaid coverage due to the new provisions.

This coverage loss will lead to an estimated 405,706 missed mammograms, 679,745 missed colorectal screenings, and 67,213 missed lung cancer screenings.

As a result, 1055 breast cancers, 748 colorectal cancers, and 538 lung cancers will go undetected, with excess deaths totaling 155 — 70 for breast, 50 for colorectal, and 35 for lung cancers.

Predicted missed screenings and related cancer outcomes varied considerably by state, with missed screening rates generally lower in states that didn’t expand Medicaid.

“Importantly, our estimates focus on missed screening and do not account for patients already undergoing cancer treatment whose coverage could be interrupted, meaning the real-world impact is likely larger,” Diaz said.

Farhad Islami, MD, PhD, senior scientific director of Cancer Disparity Research at the American Cancer Society, said the estimated coverage losses are “consistent with the number” — 7.8 million — “estimated by the nonpartisan Congressional Budget Office.”

Islami also stressed that the harm caused by the new restrictions would be “far greater” than what the study reports, with coverage losses leading to delays in care seeking for cancer symptoms of all kinds “and consequently, delayed diagnosis for many more cancer cases.”

“Moreover,” he added, “the restrictions can reduce the utilization of preventive care (eg, counselling and pharmacotherapy for smoking cessation among people who smoke, counselling for reducing weight, and so on) and receipt of guideline-concordant cancer treatments among those who will lose Medicaid coverage.”

In Diaz’ view, clinicians can help mitigate the adverse effects of the new provisions.

“For example, proactively identifying patients at risk of coverage loss, engaging financial counselors and social workers early, and connecting uninsured or underinsured patients to safety-net screening and treatment programs,” he said. “At a systems level, clinicians also have an important role in documenting and communicating these downstream clinical consequences to health systems and policymakers.”

A version of this article first appeared on Medscape.com.

Tightened Medicaid eligibility rules under the 2025 Budget Reconciliation Bill could result in more than 1 million missed cancer screenings within 2 years and over 150 avoidable cancer deaths, new findings suggested.

“Clinicians should be genuinely concerned,” corresponding author Adrian Diaz, MD, MPH, a surgical oncology fellow at the University of Chicago, Chicago, told Medscape Medical News. “These projections suggest that Medicaid eligibility restrictions are likely to translate into delayed diagnoses, more advanced disease at presentation, and worse outcomes.”

The new law, which significantly reduces federal Medicaid funding, introduces mandatory work or community-engagement requirements for working-age adults as well as more frequent recertification starting in 2027.

In the study, a Research Letter published online on January 8 in JAMA Oncology, Diaz and Sarah Shubeck, MD, also from the University of Chicago, drew on data from Arkansas to model how these 2025 federal Medicaid eligibility restrictions could lead to loss of Medicaid coverage and consequently missed cancer screenings, especially in states that expanded Medicaid.

Diaz and Shubeck then paired coverage losses with state-level self-reported screening prevalences and estimated incident breast, colorectal, and lung cancers using 2-year risks.

In the first 2 years after implementation, the researchers predicted that 7.5 million adults (range, 5.0-10.8 million) will lose Medicaid coverage due to the new provisions.

This coverage loss will lead to an estimated 405,706 missed mammograms, 679,745 missed colorectal screenings, and 67,213 missed lung cancer screenings.

As a result, 1055 breast cancers, 748 colorectal cancers, and 538 lung cancers will go undetected, with excess deaths totaling 155 — 70 for breast, 50 for colorectal, and 35 for lung cancers.

Predicted missed screenings and related cancer outcomes varied considerably by state, with missed screening rates generally lower in states that didn’t expand Medicaid.

“Importantly, our estimates focus on missed screening and do not account for patients already undergoing cancer treatment whose coverage could be interrupted, meaning the real-world impact is likely larger,” Diaz said.

Farhad Islami, MD, PhD, senior scientific director of Cancer Disparity Research at the American Cancer Society, said the estimated coverage losses are “consistent with the number” — 7.8 million — “estimated by the nonpartisan Congressional Budget Office.”

Islami also stressed that the harm caused by the new restrictions would be “far greater” than what the study reports, with coverage losses leading to delays in care seeking for cancer symptoms of all kinds “and consequently, delayed diagnosis for many more cancer cases.”

“Moreover,” he added, “the restrictions can reduce the utilization of preventive care (eg, counselling and pharmacotherapy for smoking cessation among people who smoke, counselling for reducing weight, and so on) and receipt of guideline-concordant cancer treatments among those who will lose Medicaid coverage.”

In Diaz’ view, clinicians can help mitigate the adverse effects of the new provisions.

“For example, proactively identifying patients at risk of coverage loss, engaging financial counselors and social workers early, and connecting uninsured or underinsured patients to safety-net screening and treatment programs,” he said. “At a systems level, clinicians also have an important role in documenting and communicating these downstream clinical consequences to health systems and policymakers.”

A version of this article first appeared on Medscape.com.

Tightened Medicaid eligibility rules under the 2025 Budget Reconciliation Bill could result in more than 1 million missed cancer screenings within 2 years and over 150 avoidable cancer deaths, new findings suggested.

“Clinicians should be genuinely concerned,” corresponding author Adrian Diaz, MD, MPH, a surgical oncology fellow at the University of Chicago, Chicago, told Medscape Medical News. “These projections suggest that Medicaid eligibility restrictions are likely to translate into delayed diagnoses, more advanced disease at presentation, and worse outcomes.”

The new law, which significantly reduces federal Medicaid funding, introduces mandatory work or community-engagement requirements for working-age adults as well as more frequent recertification starting in 2027.

In the study, a Research Letter published online on January 8 in JAMA Oncology, Diaz and Sarah Shubeck, MD, also from the University of Chicago, drew on data from Arkansas to model how these 2025 federal Medicaid eligibility restrictions could lead to loss of Medicaid coverage and consequently missed cancer screenings, especially in states that expanded Medicaid.

Diaz and Shubeck then paired coverage losses with state-level self-reported screening prevalences and estimated incident breast, colorectal, and lung cancers using 2-year risks.

In the first 2 years after implementation, the researchers predicted that 7.5 million adults (range, 5.0-10.8 million) will lose Medicaid coverage due to the new provisions.

This coverage loss will lead to an estimated 405,706 missed mammograms, 679,745 missed colorectal screenings, and 67,213 missed lung cancer screenings.

As a result, 1055 breast cancers, 748 colorectal cancers, and 538 lung cancers will go undetected, with excess deaths totaling 155 — 70 for breast, 50 for colorectal, and 35 for lung cancers.

Predicted missed screenings and related cancer outcomes varied considerably by state, with missed screening rates generally lower in states that didn’t expand Medicaid.

“Importantly, our estimates focus on missed screening and do not account for patients already undergoing cancer treatment whose coverage could be interrupted, meaning the real-world impact is likely larger,” Diaz said.

Farhad Islami, MD, PhD, senior scientific director of Cancer Disparity Research at the American Cancer Society, said the estimated coverage losses are “consistent with the number” — 7.8 million — “estimated by the nonpartisan Congressional Budget Office.”

Islami also stressed that the harm caused by the new restrictions would be “far greater” than what the study reports, with coverage losses leading to delays in care seeking for cancer symptoms of all kinds “and consequently, delayed diagnosis for many more cancer cases.”

“Moreover,” he added, “the restrictions can reduce the utilization of preventive care (eg, counselling and pharmacotherapy for smoking cessation among people who smoke, counselling for reducing weight, and so on) and receipt of guideline-concordant cancer treatments among those who will lose Medicaid coverage.”

In Diaz’ view, clinicians can help mitigate the adverse effects of the new provisions.

“For example, proactively identifying patients at risk of coverage loss, engaging financial counselors and social workers early, and connecting uninsured or underinsured patients to safety-net screening and treatment programs,” he said. “At a systems level, clinicians also have an important role in documenting and communicating these downstream clinical consequences to health systems and policymakers.”

A version of this article first appeared on Medscape.com.