Early Impact of Medicaid Expansion and Quality of Breast Cancer Care in Kentucky

Nicolas Ajkay, Neal Bhutiani, Bin Huang, Quan Chen, Jeffrey D. Howard, Thomas C. Tucker, Charles R. Scoggins, Kelly M. McMasters, Hiram C. Polk

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background: In January 2014, Kentucky expanded Medicaid coverage to include all individuals and families with incomes up to 33% above the federal poverty line. This study evaluated the early impact of Medicaid expansion on some aspects of the quality of breast cancer care in Kentucky. Study Design: The Kentucky Cancer Registry was queried for all women aged 20 to 64 years diagnosed with breast cancer between 2011 and 2016. Demographic, tumor, and treatment characteristics were assessed for each year during this interval. To evaluate the association between Medicaid expansion and these parameters, these variables, along with quality metrics deriving from said variables, were compared for the years 2011 to 2013 (pre) and the years 2014 to 2016 (post). Results: Of 13,625 women with breast cancer, 11,915 (59.5%) were diagnosed and treated from 2011 to 2013, and 8,127 (40.5%) were diagnosed and treated from 2014 to 2016. After Medicaid expansion, fewer patients were uninsured (3.7% post vs 1.0% pre) and more were covered by Medicaid (15.9% post vs 10.9% pre) (p < 0.001). There was increased diagnosis of early stage (I and II) breast cancer (p = 0.002) and an increasing proportion of women undergoing breast-conservation therapy (p < 0.001). Time from diagnosis to operation increased (p < 0.001), time from operation to chemotherapy remained unchanged (p = 0.26) and time from operation to radiation decreased (p < 0.001). Conclusions: The expansion of Kentucky Medicaid in 2014 has been associated with earlier diagnosis and somewhat improved quality of breast cancer care, despite a stable disease incidence. Additional improvements in treatment expediency will require improvements in patient outreach and healthcare infrastructure.

Original languageEnglish
Pages (from-to)498-504
Number of pages7
JournalJournal of the American College of Surgeons
Issue number4
StatePublished - Apr 2018

Bibliographical note

Publisher Copyright:
© 2018 American College of Surgeons

ASJC Scopus subject areas

  • Medicine (all)


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