# Prevalence of Colorectal Cancer Screening Among Latino Adults Following the Medicaid Eligibility Amendment Expansion

## TL;DR

Expanding Medicaid to all adults, regardless of immigration status, increased colorectal cancer screening rates among Latino and Latina adults, especially those who were previously uninsured.

## Contribution

This study shows that Medicaid eligibility expansion improves cancer screening access for Latino and Latina adults, particularly those with Spanish or English language preferences.

## Key findings

- Medicaid expansion increased screening rates among uninsured English-preferring Latino and Latina patients by 19.53 percentage points.
- Spanish-preferring Latina women saw an 8.58 percentage point increase in screening rates after Medicaid expansion.
- The study highlights the potential of state-funded insurance expansions to reduce disparities in cancer screening.

## Abstract

Was expanding Medicaid eligibility to all adults regardless of immigration status associated with an improvement in the prevalence of colorectal cancer screening among Latino and Latina adults?

In this case-control study of 6503 Latino and Latina patients, expanding Medicaid regardless of immigration status was associated with increased prevalence of colorectal cancer screening among uninsured Latina patients with a Spanish-language preference and Latino and Latina patients with an English-language preference.

The findings of this study suggest that state-funded insurance coverage expansions may help increase colorectal cancer–screening prevalences among Latino and Latina adults.

This case-control study examines whether there were changes in the prevalence of colorectal cancer screening among Latino and Latina adults following amendments in California and Oregon that expanded Medicaid eligibility to adults aged 50 years and older regardless of immigration status.

Cancer is the leading cause of death for Latino and Latina individuals in the US. Lack of insurance is one of the leading contributing factors to low prevalence of colorectal cancer screening. In 2021, the state Medicaid coverage programs in California and Oregon were amended to expand income-based eligibility for Medicaid to adults aged 50 years or older regardless of immigration status.

To evaluate whether expanding Medicaid eligibility regardless of immigration status to adults aged 50 years or older with low income was associated with improvements in the prevalence of up-to-date colorectal cancer screening among Latino and Latina patients who received care at community health centers.

This retrospective case-control study used electronic health record data from clinics from January 2018 to December 2023 in states that expanded Medicaid eligibility regardless of immigration status by 2021 (California and Oregon) and from those that did not amend their eligibility (Indiana, Minnesota, Ohio, and Washington). The dataset included Latino and Latina patients aged 50 to 63 years who were uninsured at baseline and had visits both before (2018-2019) and after (2021-2023) the Medicaid eligibility amendment (excluding 2020 because of the COVID-19 pandemic and its association with primary care delivery).

State adoption of the 2021 Medicaid income-based eligibility amendment regardless of immigration status to adults aged 50 years or older.

The prevalence of up-to-date colorectal cancer screening was assessed using a doubly robust covariate-adjusted difference-in-differences model to estimate the average treatment effect on the treated (ATT).

There were 6503 Latino and Latina patients (mean [SD] age, 54.04 [3.32] years; 3623 females [55.7%]) from 218 clinics included in the study, of whom 5957 (91.6%) preferred the Spanish language. The prevalence (in percentage points) of colorectal cancer screening increased among uninsured English-preferring Latino and Latina patients (ATT = 19.53 [95% CI, 9.04-30.02]), English-preferring Latino men (ATT = 16.72 [95% CI, 1.27-32.16]) when considering all 3 years of the posteligibility period, and Spanish-preferring Latina women (ATT = 8.58 [95% CI, 1.48-15.67]) in the third posteligibility year in eligibility amendment states more than their counterparts in nonamendment states.

In this case-control study of Latino and Latina patients, expansion of Medicaid eligibility was associated with significantly higher prevalence of colorectal cancer screening rates among Spanish-preferring Latina women and English-preferring Latino and Latina patients. The findings suggest that state-funded coverage expansions may help increase colorectal cancer–screening prevalences in this population.