Medicaid: Supporting the Multidisciplinary Care Continuum

By the Association for Clinical Oncology

Since the passage of the Affordable Care Act, Medicaid has become a vital component for improving cancer prevention, early detection and treatment. For multidisciplinary teams, Medicaid expansion has fundamentally changed the clinical landscape, allowing for earlier diagnoses when treatment options are often more effective and less intensive for the patient. It has also led to improved insurance coverage stability, increased receipt of guideline-concordant care and reductions in cancer-related disparities.

However, the July 2025 budget reconciliation act (H.R. 1) introduced significant structural changes to Medicaid that may pose challenges to this continued progress.

The changes include:

• Enhanced redetermination requirements: more frequent and rigorous administrative steps to confirm patient eligibility.
• Cost-sharing measures: increases in out-of-pocket responsibilities for some enrollees.
• Work requirements: A mandate for enrollees aged 19 to 64 without dependents to participate in 80 hours of work, education or community service per month.

These updates are projected to reduce federal spending by $1 trillion over the next decade.

The impact of work requirements effective in 2027

Under H.R. 1, states that have expanded Medicaid must implement work requirements by the end of 2026. Additionally, patients must demonstrate compliance for at least one month before applying for coverage and maintain them to stay enrolled.

These requirements may present new barriers to consistent care. ASCO  has expressed concern  that these mandates are often impractical for those in active cancer treatment, as the side effects of oncology therapies frequently limit a patient’s ability to maintain steady employment.

While the law includes exemptions for those considered “medically frail” or having a “complex medical condition,” these terms currently lack specific federal definitions. Without clear guidance from the Centers for Medicare & Medicaid Services (CMS), interpretations of these definitions will vary state to state. This could lead to a lack of uniformity, potentially leaving patients in a state of uncertain coverage during critical phases of their care.

ASCO’s advocacy and support

ASCO is working to bridge the gap between policy and clinical practice through several key initiatives aimed at protecting patient access to care:

• Advocating for standardized exemptions: ASCO has actively urged policymakers at the federal and state level to establish a clear, universal exemption for any patient in active cancer treatment to ensure that they can continue to be enrolled in Medicaid or do not lose coverage due to their inability to work. ASCO is also speaking with CMS regarding the exemptions and is planning to submit policy recommendations.

The professional’s role in advocacy

The Congressional Budget Office estimates that up to 10 million people could lose Medicaid coverage over the next decade. For multidisciplinary health care teams, this underscores the importance of a unified voice to ensure that patients do not face new obstacles to the care they need.

To ensure the progress made in cancer care continues, providers are encouraged to:

• Stay informed: Follow ongoing policy updates through ASCO in Action.
• Engage: Learn about legislation in your state and throughout the country that could impact cancer care and the practice of oncology.

Published February 20, 2026