It's notorious that Medicaid is fifty separate programs, with their own websites, quirks, and rules. In this blog, we point to papers on (1) biomarker coverage and (2) preventive services coverage.
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It's notorious that Medicaid is fifty separate programs, with their own websites, quirks, and rules. Or even more than that, when a state has multiple competing Medicaid Managed Care organizations. (And Managed Medicaid, as opposed to a state-operated fee for service program, is well more than half of Medicaid).
I ran across two useful references that both demonstrate, and attempt to summarize, the diversity of Medicaid programs.
Medicaid and Lung Cancer Coverage
The first is a 20 page white paper from the lung cancer association, Lungevity, a "state scorecard" for cancer-related coverage. Find it here. The report was undertaken by the consultancy ADVI.
For example, only 39% of states cover full-panel biomarker testing (code 81455):
The report includes epidemiological data as well, such as lung cancer rates and survival rates.
Medicaid and Preventive Services
The second is a peer-reviewed paper on Medicaid coverage for preventive services. A wide range of preventive services are now baked into Medicare, and commercial plans are required to cover USPSTF endorsed preventive services. [*] However, Medicaid coverage is at state discretion.
See Bloodworth et al, 2018, Variation of preventive service utilization by state Medicaid coverage, cost-sharing, and Medicaid expansion status. Pubmed here, journal Preventive Medicine here. (Pay per view, $36).
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For more on the ACA and preventive services, see e.g. Chait & Glied (2018) Ann Rev Public Health, Prevention under the Affordable Care Act, here (open access).
