Jamie Shoag, MD

Cleveland Clinic Children's


Pediatric Pilot Award

Healthcare Access and Equity in Patients and Survivors of Pediatric, Adolescent, and Young Adult Cancers Enrolled in Medicaid

Despite dramatic improvement in survival for children, adolescents, and young adults (AYA) malignancies, racial-ethnic and socioeconomic disparities persist. Insurance coverage plays an essential role for young patients who have high healthcare utilization and are especially vulnerable to the financial toxicity of cancer care. Poorer outcomes have been reported for children and AYA with public or no insurance compared to those who are privately insured. Currently, data on insurance status in cancer patients rely on reports of insurance captured at diagnosis. However, considering insurance at one snapshot in time ignores important transitions that result from the tremendous economic burden of disease. Recent attention to Medicaid “churning”, or disruptions in Medicaid coverage, in the general population has been shown to lead to delayed care, less preventative care, negative health events (i.e., hospitalizations and emergency department visits), and higher healthcare costs.

Knowledge on the impact of Medicaid enrollment on cancer disparities in children and AYA is currently very limited. Here, we will fill this important gap by linking cancer cases from multiple cancer registries with Medicaid enrollment and claims data for these individuals from the Centers for Medicare and Medicaid Services. Because race-ethnicity and socioeconomic status (SES) are intimately intertwined in the United States, we will also explore the spectrum of racial-ethnic cancer disparities in a uniformly low SES population. This initiative is vital for stakeholder engagement to develop policies for insurance coverage that improve health equity for our most vulnerable populations.


Our project will work on merging data from the Medicaid database with the Ohio cancer registry database so we can look at the journey of children who are on Medicaid through cancer diagnosis, treatment, and into survivorship. The goal of our study is to figure out why there are large inequities between survival from pediatric cancer so that future initiatives can help reduce those inequities and help survival rates in minority groups.