Changes in breast and cervical cancer screening rates among Latinas after Medicaid expansion

Abstract

Introduction: 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 and older, on breast and cervical cancer screenings among Latina patients at community health centers (CHCs).

Methods: This retrospective cohort study used electronic health record data from CHCs in states that expanded eligibility (CA, OR) and those that did not (AK, CT, IN, MN, MT, NJ, OH, WA). Data included 18,209 non-pregnant Latina patients aged 50-64 who had visits both pre- (2018-2019) and post- amendment (2021-2023). Data were analyzed in 2024-2025, and a doubly robust, covariate-adjusted difference-in-differences model estimated the average treatment effect on the treated (ATT) for screening outcomes.

Results: Among previously uninsured patients, Spanish-preferring Latinas in eligibility amendment states had significantly greater increases in up-to-date breast (ATT = +9.13; 95% CI: 3.36-14.90) and cervical (ATT = +11.03; 95% CI: 5.77-16.29) cancer screenings compared to non-amendment states. English-preferring Latinas in amendment states showed a significant breast screening increase only in year three (all insurance: ATT = +11.73; 95% CI: 1.61-21.85; uninsured in pre-period: ATT = +23.42; 95% CI: 2.11-44.72). For those with any insurance, only Spanish-preferring Latinas had a significant year-three increase in cervical screening (ATT = +14.66; 95% CI: 6.11-23.21).

Conclusions: State-funded coverage expansions can increase cancer screening rates and potentially reduce cancer burden among Latinas.

Keywords: Health insurance; Latina; Medicaid expansion; cancer screening; disparities; primary care.