Medicaid Work Requirements Could Reduce Vulnerable Patients’ Access to Cancer Care

ASCO Issues Recommendations to Preserve Patients’ Ability to Access High-Quality Cancer Care in New Position Statement
August 16, 2018

The American Society of Clinical Oncology (ASCO) warns that Medicaid work requirements may hinder patients’ access to essential cancer care and reduce the already limited time physicians are able to spend with their patients. In a new position statement released today, ASCO also recommends that federal and state policymakers take specific steps to ensure that new Medicaid requirements will not harm patients with cancer.  

The ASCO position statement, “Medicaid Waivers & Their Impact on Cancer Care," comes as several states have recently submitted waivers to the Centers for Medicare & Medicaid Services (CMS) asking the agency to approve changes to the Medicaid program in their state that would make eligibility, continued coverage, cost-sharing, and other program benefits dependent on a beneficiary’s work status. Some state waivers have requested the authority to cut coverage for beneficiaries based on not paying premiums, eligibility redeterminations, and work requirements.

“ASCO calls on CMS to reject any state waivers that would hinder access to high-quality care for patients with cancer or people at increased risk for cancer,” said ASCO President Monica M. Bertagnolli, MD, FACS, FASCO. “We are deeply concerned that more restrictive Medicaid eligibility policies will cause unnecessary delays in screening and care, and ultimately, worse outcomes for patients with cancer.”

The statement also underscores how Medicaid work requirements, which require verification of the patient’s work status from a physician, are adding to the growing administrative burden providers face, further cutting into their time with patients. The statement cites a recent finding that physicians currently spend 49 percent of their office hours updating records and files rather than treating patients.

“Medicaid work requirements will place an even greater administrative burden on physicians, thereby putting patients with cancer who participate in Medicaid at further risk of not receiving the high-quality care they deserve,” said Dr. Bertagnolli.

ASCO strongly urges state and federal policymakers to focus on the impact new Medicaid policies can have on patients with cancer and to adopt the following recommendations:

  • CMS should not approve any waivers or state plan amendments that would serve to create delays or barriers to timely and appropriate access to cancer care.
  • States should deem patients in active treatment for cancer as exempt from any work or community engagement requirements (such as job skills training or public service). ASCO encourages states to consider the primary caregivers for patients in active cancer treatment for a similar exemption. 
  • For patients in active treatment for cancer and survivors of cancer treatment, states should not impose lockout periods, lifetime limits or elimination of retroactive eligibility for a minimum of one year after last treatment. CMS should codify these exemptions as a matter of federal policy.
  • States should deem survivors of cancer treatment for a minimum of one year after their last treatment as exempt from any work or community engagement requirements (such as job skills training or public service). This exemption should allow for clinically appropriate exemptions as deemed by a provider. States should not prevent survivors from participating if they wish to do so. 
  • CMS should not approve any waivers that place additional uncompensated burdens on cancer care providers.
  • CMS and states should ensure that all 1115 waiver applications and amendments are open to a full and transparent public comment period.  

Read the statement.  

This statement is the latest from ASCO urging policymakers to preserve and enhance access to high-quality care for all Americans. In 2014, “American Society of Clinical Oncology Policy Statement on Medicaid Reform,” called for major changes to the Medicaid program to ensure access to high-quality cancer care for all low-income individuals. Similarly, ASCO’s 2017 “Principles for Patient-Centered Health Care Reform” called for access to affordable and sufficient healthcare coverage regardless of income or health status.