Introduction: While the Affordable Care Act has led to increased insurance rates amongst patients seeking urologic oncology care, most estimates on the improvement in oncologic outcomes have been conducted through hospital-based registries. These registries may not account for biases and variations in Medicaid acceptance amongst facilities. Empirical, patient-based estimates are needed to better understand barriers in access for Medicaid-practices for urologic malignancies. Methods: Using a secret shopper approach, we contacted a representative sample of 389 Commission-on-Cancer accredited hospitals across the United States. Trained volunteers posed as a family member seeking urologic cancer care for their father with a simulated newly diagnosed renal mass. Facility-level characteristics were accessed from several publicly available databases. The primary outcome was to estimate Medicaid acceptance for urologic cancer care nationally. The secondary outcomes were to determine facility characteristics linked that increased or decreased the likelihood of Medicaid acceptance. Results: 14.4% of Commission-on-Cancer urologic facilities did not accept new Medicaid patients. Importantly, acceptance was positively linked with state Medicaid expansion status (90.1% for expansion states vs non-expansion states 22.6% p<0.001), and higher state Medicaid-to-Medicare Fee indices (average of 0.700 for accepting facilities vs 0.649 for non-accepting facilities). Major teaching hospitals (93.8%) were more likely to accept Medicaid than non-major teaching hospitals (83.4%, p = 0.018). Medical school affiliated hospitals were also more likely to accept Medicaid (89.2% acceptance for medical school affiliated hospitals vs 79.7% for non-medical school affiliated facilities, p=0.01). All other queried facility-level characteristics did not reach statistical significance. Conclusions: Using a secret shopper approach, we estimated Medicaid acceptance for urologic cancer care in a nationally representative sample of accredited cancer facilities from the patient perspective. We show that factors such as state Medicaid expansion status, Medicaid reimbursement, and teaching status were strongly associated with Medicaid Acceptance. SOURCE OF Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
