To better understand the barriers that people face when trying to enroll and maintain health care coverage in Medicaid and the Children’s Health Insurance Program (CHIP), the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking feedback on health care access issues including difficulties enrolling and maintaining coverage, accessing services and support, and ensuring adequate provider reimbursement to encourage provider availability and quality.
In its response to the RFI, the Association for Clinical Oncology (ASCO) strongly agrees with CMS that all eligible individuals should be able to apply, enroll in, and receive Medicaid coverage benefits in a timely and streamlined manner that promotes equitable health care coverage. ASCO’s comments highlight how important this is for people with cancer, as enrollment delays or restrictions result in disruptions in care, and delays in screening and treatment. Additionally, as millions of patients with Medicaid coverage are now able to participate in clinical trials, which often provide the best—and sometimes only—treatment option for their disease, consistent enrollment in Medicaid coverage benefits is crucial to advance oncology care and research.
CMS acknowledges that for beneficiaries to have comparable access to services, compared to the general population, sufficient practitioners must enroll as Medicaid/CHIP providers. As such, ASCO’s comments support the need for policies and practices that protect and promote payment reforms that improve health equity. Insufficient provider payments jeopardize beneficiary access to care, and ASCO recommends that Medicaid programs focus on and reward care that emphasizes the quality rather than the amount of care provided.
CMS sought feedback on ways to ease provider burden and encourage participation in the Medicaid program. ASCO’s comments highlight how Association members have identified prior authorization requirements as a primary factor leading to physician burden and burnout. Prior authorization programs are having a detrimental impact on oncology care as they can lead to delays in starting physician-recommended treatment, treatment changes or abandonment, unexpected out of pocket costs, and rejection of physician-recommended treatment.
ASCO is committed to advocating for coverage and reimbursement, access and quality, and cancer research and prevention policies that promote high-quality, equitable cancer care throughout the health care system.
Read the full RFI response.
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