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Medicaid Reimbursement for Cancer Screening Lags Inflation

August 2011 Vol 4, No 4, Special Issue

Medicaid reimbursement for many cancer screenings is not keeping pace with inflation, at least in the 4 states examined in an analysis by Michael T. Halpern, MD, PhD, Senior Health Scientist, Health Services and Social Policy Research, RTI International, a provider of research and technical services to governments and businesses based in Washington, DC.

In describing the impetus for the study, Dr Halpern noted, “low reimbursements for cancer screening services among Medicaid enrollees may limit their access to these services and thus decrease the likelihood of early cancer diagnosis.”

Examining Medicaid outpatient claims data from Georgia, Illinois, Louisiana, and Maine from 2000 to 2003, Dr Halpern and colleagues assessed an - nual changes in Medicaid reimbursements for cancer screening services.Claims for screening tests for breast cancer (mammography), cervical cancer (Pap smear), colorectal cancer (barium enema, flexible sigmoidoscopy, colonoscopy, fecal occult blood test), and prostate cancer (prostate-specific antigen [PSA] test), as well as for physician office visits, were identified using Current Procedural Terminology codes.

Average reimbursement rates were assessed annually and adjusted for inflation using the medical care component of the Consumer Price Index from the Bureau of Labor Statistics.

“The patterns of changes in reimbursements varied by state, with 2 states showing reimbursements that did not keep pace with inflation for all or almost all services examined,” said Dr Halpern.

After adjustment for inflation, Medicaid reimbursement for all colorectal cancer screening tests in each of the 4 states decreased from 2000 to 2003. Decreases in colonoscopy reimbursements over these 4 years ranged from $10.66 (3.8%) in Louisiana to $44.60 (17.3%) in Illinois.

Reimbursements for PSA testing also decreased over time in all 4 states, ranging from 12.2% to 19.2%. Mam - mography reimbursements during the study period increased by almost 5% in Georgia (from $29.62 to $31.00) but decreased in the other 3 states, including a decrease of >40% in Maine (from $22.78 to $13.00). The average reimbursements for physician office visits increased in Georgia (9.1%) and Louisiana (5.3%) but decreased in Illinois and Maine (both 12.2%).

Last modified: August 30, 2021