Differences in definitive head and neck cancer treatment by hospital accreditation and Medicaid enrollment

• Quality care delivered by accredited hospitals could improve head and neck cancer (HNC) outcomes. • We analyzed SEER-Medicaid, a population-based linkage with verified Medicaid data. • Medicaid enrollees received HNC care at CoC hospitals consistent with non-enrollees. • Medicaid patients were less likely to receive surgery, particularly those with discontinuous coverage. • In accredited hospitals only, Medicaid enrollees received postoperative radiotherapy consistent with non-enrollees. Head and neck cancer (HNC) requires multidisciplinary treatment, of which Medicaid enrollees have challenges accessing. Whether Commission on Cancer (CoC) accreditation can standardize HNC treatment for Medicaid enrollees has yet to be assessed. We analyzed SEER-Medicaid data of 47,899 patients diagnosed with HNC between 2018–2019. Using verified Medicaid enrollment files, we identified Medicaid status at diagnosis and categorized enrollees by coverage continuity. With linear regression models adjusting for tumor, individual, and geographic factors, we 1) tested for differences in access to CoC-accredited hospitals and 2) tested if the association between Medicaid enrollment and treatment (surgery on the primary site, postoperative radiotherapy) varied by CoC-accreditation status. Overall, 18% of patients were enrolled in Medicaid at diagnosis, half of whom maintained continuous coverage for two years. Even after adjusting for other factors, Medicaid enrollees were 1.8%-points more likely than non-enrollees to receive definitive care at a CoC-accredited hospital, with the largest advantage found in continuously enrolled patients (2.9%-points). Regardless of hospital accreditation status, Medicaid enrollees were less likely to receive primary site surgery. This disparity was driven by those with discontinuous coverage. Finally, among patients receiving surgery, Medicaid enrollees at non-CoC hospitals were 3.4%-points less likely to receive postoperative radiotherapy, with no differences among Medicaid enrollees at CoC-accredited hospitals. Continuous Medicaid enrollment and treatment at CoC-accredited hospitals appeared critical for HNC treatment, underscoring the importance of policies advancing continuity and standardization of care in pursuit of improving HNC care delivery in Medicaid funded cancer control systems.