Changes in Breast and Cervical Cancer Screening Rates Among Latinas After Medicaid Expansion.

Abstract

Breast and cervical cancers are significant health concerns among Latinas, who are less likely to receive up-to-date cancer screenings. Barriers, including lack of insurance, contribute to this disparity. This study examined the impact of the 2021 Medicaid eligibility amendment in California and Oregon, which expanded coverage to all income-eligible adults aged ≥50 years on breast and cervical cancer screenings among Latina patients at community health centers. This retrospective cohort study used electronic health record data from community health centers in states that expanded eligibility (California and Oregon) and those that did not (Alaska, Connecticut, Indiana, Minnesota, Montana, New Jersey, Ohio, and Washington). Data included 18,209 nonpregnant Latina patients aged 50-64 years who had visits both before (2018-2019) and after (2021-2023) amendment. Data were analyzed in 2024-2025, and a doubly robust, covariate-adjusted difference-in-differences model estimated the average treatment effect on the treated for screening outcomes. Among previously uninsured patients, Spanish-preferring Latinas in eligibility amendment states had significantly greater increases in up-to-date breast (average treatment effect on the treated= +9.13; 95% CI=3.36, 14.90) and cervical (average treatment effect on the treated= +11.03; 95% CI=5.77, 16.29) cancer screenings than nonamendment states. English-preferring Latinas in amendment states showed a significant breast screening increase only in Year 3 (all insurance: average treatment effect on the treated= +11.73; 95% CI=1.61, 21.85; uninsured in pre amendment period: average treatment effect on the treated= +23.42; 95% CI=2.11, 44.72). For those with any insurance, only Spanish-preferring Latinas had a significant year-3 increase in cervical screening (average treatment effect on the treated= +14.66; 95% CI=6.11, 23.21). State-funded coverage expansions can increase cancer screening rates and potentially reduce cancer burden among Latinas.