Access to cancer care for undocumented immigrants in the United States.

11034 Background: Undocumented immigrants represent a disproportionate share of uninsured individuals in the United States, owing to federal restrictions on Medicaid eligibility. Emergency Medicaid (EM) and other state programs offer avenues for healthcare coverage, but their impact on access to cancer care remains poorly understood. Methods: Between January-July 2024, information on the availability and breadth of cancer coverage for undocumented immigrants under EM and other insurance mechanisms were reviewed for all 50 states and the District of Columbia (D.C.). For each state, ≥4 authors reviewed publicly available data compiled from multiple, independent sources including Medicaid policy handbooks, provider manuals, legislative documents, and other state government website resources. Abstracted data included state-specific information on extent of coverage, specifically as it pertains to cancer diagnosis, treatment, and follow-up care. Discrepancies in policy findings were discussed during consensus meetings to ensure accurate interpretation. In cases where policies remained unclear, state Medicaid agencies were directly contacted for further clarification. Results: Undocumented immigrants receive cancer care coverage via (1) expansions to EM ( n =3), (2) Medicaid-equivalent programs ( n =7), or (3) other non-Medicaid mechanisms ( n =5; Table). Of the 6 states and D.C. with Medicaid-equivalent plans, 4 states and D.C. cover all adults, while 2 states only cover some adults (IL: limited to adults age ≥42; NY: limited to adults age ≥65, but adults age <65 can receive cancer coverage via EM). Of the 5 states with non-Medicaid mechanisms, 2 states (CO, WA) allow purchase of commercial plans on the ACA Marketplace or Marketplace-like platform; other strategies include Iowa’s Breast and Cervical Cancer Treatment Program (BCCTP), Massachusetts’ Health Safety Net program, or New Mexico’s high-risk insurance pool. The remaining 35 states had no documented cancer coverage mechanism. Conclusions: In this national analysis of EM and other policies supporting healthcare coverage for undocumented immigrants, access to cancer care remains fragmented, intermittent, and largely limited to the emergency setting. Although Medicaid-equivalent plans and Marketplace-based offer promising avenues for comprehensive coverage, budgetary constraints and political challenges pose threats to viability. Absent federal support, sustainable policy solutions are needed to ensure continued progress towards a more equitable model of care. Emergency Medicaid Medicaid-Equivalent Plan Other Mechanism California All adults Colorado Marketplace-like D.C. All adults Illinois Adults (age ≥42) Iowa BCCTP Maryland All adults Massachusetts Health Safety Net Program Minnesota All adults New Mexico High-risk insurance pool New York Adults (age <65) Adults (age ≥65) Oregon All adults Pennsylvania All adults Washington All adults Marketplace