Medicaid Coverage Continuity is Associated with Lymphoma Stage among Children and Adolescents/Young Adults

Lymphoma is the third leading cause of cancer among children and adolescents/young adults (AYAs) in the United States, with later-stage diagnoses often linked to worse outcomes. Continuous health insurance coverage is crucial for facilitating early cancer detection and diagnosis. Among Medicaid-insured children and AYAs diagnosed with lymphoma, this study examines whether the timing of Medicaid enrollment and coverage continuity are associated with stage at diagnosis. Using the SEER-Medicaid data, we identified children and AYAs (aged 0-39 years) newly diagnosed with lymphoma between 2007-2013 in 12 states that were linked to the administrative Medicaid data. Medicaid enrollment patterns were categorized into continuous Medicaid (preceding and through diagnosis), newly gained Medicaid (at or shortly after diagnosis), and other Medicaid enrollment patterns. We defined late-stage as Ann-Arbor stage IV (vs. stage I-III). Multiple logistic regressions were estimated, with marginal effects (MEs) reported. Of 3,524 patients identified, 37.8% had continuous Medicaid, followed by newly gained Medicaid (35.2%) and other Medicaid enrollment patterns (27.0%). Compared to patients continuously enrolled in Medicaid, those with newly gained Medicaid and with other Medicaid enrollment patterns were 54% (ME=13.9 percentage points [ppt]; 95% confidence interval [CI]=8.5 to 19.2; p<0.001) and 18% (ME=4.6 ppt; 95% CI=2.2 to 7.0; p<0.001), respectively, more likely to present with stage IV lymphoma. Together, having continuous Medicaid coverage before diagnosis was associated with a lower likelihood of late-stage lymphoma at diagnosis; however, only three in eight Medicaid-insured children and AYAs with lymphoma were continuously enrolled in Medicaid before their diagnosis.