Missouri law change boosts breast cancer screening rates among Medicaid population

A recent Missouri law change boosted breast cancer screening rates among the Medicaid population alongside other benefits, according to new Neiman Health Policy Institute research published Thursday. 

The Show Me State in 2019 passed legislation lowering the age at which insurers are mandated to cover annual mammograms from 50 to 40. In addition, the bill required reimbursement for 3D mammography, also known as digital breast tomosynthesis. 

Researchers recently assessed the law’s impact, comparing breast cancer screening rates for Missouri women against other states without such legislative changes, sharing their findings in JACR. After the 2019 update, women on Medicaid or commercial insurance saw a greater increase in their likelihood of undergoing screening mammography compared to those with Medicare Advantage plans. 

“This study shows that policy change matters—and can improve access to lifesaving screening,” lead author Amy K. Patel, MD, medical director of the Breast Care Center at Liberty (Mo.) Hospital, said in a July 24 announcement from the Policy Institute. “In Missouri, where we face some of the nation’s worst disparities in breast cancer outcomes, this legislation is moving the needle in the right direction.”

The analysis gathered its information from a national claims database, comparing Medicaid and commercial beneficiaries to those with federally regulated Medicare Advantage plans. They also further examined the law's impact by comparing Missouri women to similar counterparts in bordering states without coverage updates. In all, the sample included over 1 million unique women, about 41% of whom lived in the Midwestern state. 

Following the law change, women on Medicaid were about 45% likelier to undergo breast cancer screening than those with Medicare Advantage plans. That’s compared to about 5% likelier for those with commercial insurance. Medicaid beneficiaries also had a higher chance of receiving 3D mammography than other women in Missouri (odds ratio of 2.31) and in bordering states (OR: 1.24). Commercially insured women, likewise, saw a relative increase in their likelihood of receiving DBT, the study found. Meanwhile, Missouri women on Medicaid were approximately 9% more likely to have screening mammography versus those using the payment program in bordering states.  

Patel—who chairs of the ACR Radiology Advocacy Network/RADPAC—believes her team’s study offers “clear evidence” that increased coverage produces “real gains” in screening rates. 

“The results of our study deserve notice by other states considering similar legislation to Missouri’s,” Patel, who is the immediate past president of the Missouri Radiological Society, said in a statement. “State policy change has now shown to increase breast cancer screening and access to newer technology, particularly among underserved women. The goal is increasing annual screening for a broader base of women to increase years of life saved from breast cancer. As a specialty, broadening the reach of screening mammography generally, as well as DBT specifically, is an important health policy and population health focus for radiologists.”