Public health insurance coverage


A woman’s eligibility for health services under Medicaid can vary widely depending on which state she lives in.

In some states, she must be a parent of a dependent child and living on an income far below the federal poverty level to qualify for care. In other states, she might qualify if she is childless and working in a low-wage job earning up to twice the federal poverty level.

The generosity of Medicaid coverage offered by different states, and even to different groups within the same state, is an important factor in whether low-income women receive breast and cervical cancer screenings and are diagnosed in time for successful treatment, says Lindsay M. Sabik, Ph.D.

Sabik, an assistant professor in Virginia Commonwealth University’s Department of Health Behavior and Policy, is leading the research project “Disparities in cancer screening: The role of Medicaid policy.”

Her $1.2 million, four-year project is funded primarily by the National Cancer Institute and in part by the Office of Behavioral and Social Sciences Research. Both are governed by the National Institutes of Health.

The project was timed to coincide with Medicaid expansion under the Patient Protection and Affordable Care Act, Sabik says, so it can consider the effect of Medicaid policies both before and after expansion under healthcare reform.

Her project will use existing secondary data, including survey results, medical claims and market-level data, to examine the results of past changes in Medicaid policy and to analyze ongoing Medicaid expansions.

Three key aspects of Medicaid policy will be examined in the study:

  • The effect of cost sharing, or the amount Medicaid patients must pay for office visits and screenings such as mammograms and pap smears. Screening copays range by state from $0 to $3. Sabik says the latter may seem nominal, but the difference between free care and some cost can make a difference in whether a woman seeks screening services.
  • Physician reimbursement rates, which ranged by state from $29 to $165 for an office visit in 2012. Whether a physician will even accept Medicaid patients is partly driven by reimbursement for services, Sabik says, adding that it’s a major factor in determining access for women. “When women call a doctor’s office, can they even make an appointment?”
  • Patient eligibility for Medicaid, which historically has been for poor children, pregnant women and disabled adults. There are other categories in most states, but in most states individuals must be “very low-income if they’re not in one of the categorically eligible groups,” Sabik says.

The disparity is wide among states. For example, Medicaid eligibility for jobless parents of dependent children ranges from an income that’s 10 percent of the federal poverty level in Alabama to an income that’s up to double the federal poverty level in Washington, D.C.

Sabik says she believes the results will show that the more women who qualify for Medicaid, the more who can receive cancer screenings, early diagnosis and improved treatment outcomes.

This research is important from a policy perspective, Sabik says, because some people argue that Medicaid, in general, is not generous enough to make a difference in keeping recipients healthy.

“We can look at states that increased their physician payment for services or decreased a patient’s cost and say something about how important Medicaid policy is,” she says.

For complete details about the study, view our current projects.