{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:59:09Z","timestamp":1791896349677,"version":"4.3.4"},"reference-count":43,"publisher":"Harborside Press, LLC","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Medicaid expansion under the Affordable Care Act primarily benefits adults aged &lt;65 years but may also indirectly benefit individuals aged \u226565 years. This study examines the associations of Medicaid expansion with insurance coverage and cancer outcomes among older patients residing in low-income areas.\n                    <jats:bold>Patients and Methods:<\/jats:bold>\n                    Using the National Cancer Database, we identified patients aged \u226565 years, newly diagnosed with cancer 2010\u20132021, and residing in areas with median household income &lt;200% of the federal poverty level. Using the quasi-experimental difference-in-differences design, multivariable models compared dual Medicare\u2013Medicaid enrollment or Medicaid-only coverage, stage at diagnosis, treatment initiation, and 2-year overall survival before and after Medicaid expansion in expansion versus non-expansion states.\n                    <jats:bold>Results:<\/jats:bold>\n                    Our sample included 1,461,540 patients. Dual Medicare\u2013Medicaid or Medicaid-only coverage increased in Medicaid expansion states (10.3%\u201311.3%) and decreased in Medicaid non-expansion states (9.4%\u20138.1%), resulting in a net increase of 1.25 percentage points (ppt; 95% CI, 1.02\u20131.48). Early-stage cancer diagnoses decreased overall, driven by prostate cancer, but declined less in expansion states than in non-expansion states, with a net adjusted relative increase of 1.00 ppt (95% CI, 0.59\u20131.41). Such protective effects were stronger for lung\/bronchus and head and neck cancers. Treatment initiation within 30 days also decreased less in expansion states than non-expansion states, with a net adjusted increase of 0.74 ppt (95% CI, 0.34\u20131.14). Two-year overall survival increased more in expansion states (58.8%\u201362.4%) than non-expansion states (59.2%\u201362.5%), leading to a net increase of 0.70 ppt (95% CI, 0.35\u20131.04). Such increase was most notable for stage IV, lung\/bronchus, kidney, and bladder cancers.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Medicaid expansion was associated with increased Medicaid coverage, attenuated declines in early-stage diagnosis and timely treatment initiation, and improved survival among low-income older patients with cancer, highlighting important spillover benefits beyond the target population.\n                  <\/jats:p>","DOI":"10.6004\/jnccn.2026.7040","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:28:37Z","timestamp":1789486117000},"source":"Crossref","is-referenced-by-count":0,"title":["Spillover Effects of Medicaid Expansion on Insurance Coverage, Diagnosis, and Survival Among Low-Income Older Patients With Cancer"],"prefix":"10.6004","volume":"24","author":[{"given":"Kewei Sylvia","family":"Shi","sequence":"first","affiliation":[{"name":"Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, GA"},{"name":"Aflac Cancer & Blood Disorders Center, Children\u2019s Healthcare of Atlanta, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Robin","family":"Yabroff","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumiko","family":"Chino","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuesong","family":"Han","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, and Health Services Research, American Cancer Society, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","series-title":"JAMA Oncol","first-page":"139","article-title":"Understanding the implications of Medicaid expansion for cancer care in the US: a review","volume":"8","author":"Ermer T","year":"2022","unstructured":"Ermer T, Walters SL, Canavan ME,  Understanding the implications of Medicaid expansion for cancer care in the US: a review. JAMA Oncol 2022;8:139\u2013148."},{"key":"B2","series-title":"JAMA Oncol","first-page":"1713","article-title":"Comparison of insurance status and diagnosis stage among patients with newly diagnosed cancer before vs after implementation of the patient protection and Affordable Care Act","volume":"4","author":"Han X","year":"2018","unstructured":"Han X, Yabroff KR, Ward E,  Comparison of insurance status and diagnosis stage among patients with newly diagnosed cancer before vs after implementation of the patient protection and Affordable Care Act. JAMA Oncol 2018;4:1713\u20131720."},{"key":"B3","series-title":"Oral Oncol","first-page":"104870","article-title":"State Medicaid expansion status, insurance coverage and stage at diagnosis in head and neck cancer patients","volume":"110","author":"Osazuwa-Peters N","year":"2020","unstructured":"Osazuwa-Peters N, Barnes JM, Megwalu U,  State Medicaid expansion status, insurance coverage and stage at diagnosis in head and neck cancer patients. 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