MEDICAID eligibility restrictions may contribute 1 million missed cancer screenings and advanced stage diagnoses, models suggest.
Medicaid Eligibility Restrictions and Coverage Loss
Researchers used a decision analytic model to estimate how projected Medicaid eligibility restrictions could affect cancer screening after implementation in January 2027. They built a monthly, state level panel of adult Medicaid enrollment, using each state’s mean enrollment from November 2024 through February 2025 as baseline and distinguishing expansion from nonexpansion adults.
The model evaluated two mechanisms: one time work requirement exits among expansion adults only (8%, 12%, or 16%) and increased churn from semiannual redeterminations applied as a 25%, 35%, or 50% uplift to baseline monthly churn (1.21%). Across scenarios, an estimated 7.5 million screening eligible Medicaid enrolled adults were projected to lose coverage over 2027 and 2028 (95% CI, 5.0 to 10.8 million).
Projected Missed Cancer Screening and Outcomes
Coverage losses were paired with state screening prevalences to estimate missed tests for breast, colorectal, and lung cancer. The authors projected 405,706 missed mammograms (95% CI, 323,947 to 495,798), 679,745 missed colorectal cancer screening tests (95% CI, 542,999 to 830,264), and 67,213 missed lung cancer screenings (95% CI, 53,663 to 82,188).
Missed screening was estimated to translate into 1,055 undetected breast cancers (95% CI, 842 to 1,289), 748 undetected colorectal cancers (95% CI, 597 to 913), and 538 undetected lung cancers (95% CI, 429 to 658). Among these, the model projected additional advanced stage presentations: 156 breast cancers (95% CI, 125 to 191), 105 colorectal cancers (95% CI, 84 to 129), and 65 lung cancers (95% CI, 52 to 79) expected to present at Stage III or IV.
State Variation and Study Limits
Projected impacts varied substantially by state, driven by baseline enrollment, the share of screening eligible adults, and the Medicaid uninsured screening gap, which may reflect differences in safety net programs. Missed screenings per enrollee were generally lower in nonexpansion states and in states with smaller screening gaps.
Limitations included reliance on self-reported screening prevalence and modeled stage shift parameters applied uniformly across demographic and geographic subgroups. The analysis also focused on three cancer sites and did not model interruptions in ongoing cancer treatment, suggesting downstream morbidity and mortality could be larger.
Reference: Shubeck SP et al. Projected Cancer Screening and Outcomes Under the 2025 Federal Medicaid Eligibility Restrictions. JAMA Oncol. 2026;doi:10.1001/jamaoncol.2025.5774.
