Medicaid Incentive Program Boosts Colorectal Cancer Screening Rates

A new statewide policy implemented by Florida Medicaid significantly increased colorectal cancer (CRC) screening rates among Medicaid enrollees, particularly younger adults, according to a comparative effectiveness study of nearly 400 000 individuals across 2 time periods.

The initiative, launched in 2022, offered financial relief from liquidated damages (LDs) to Medicaid managed care plans that achieved CRC screening rates of 50% or higher among eligible enrollees between October 1, 2022, and June 30, 2023. LD relief was scaled based on the number of enrollees screened and the screening modality used.

Florida Medicaid collaborated with Exact Sciences to facilitate clinician outreach, real-time test tracking, and access to Cologuard. Managed care plans implemented operational strategies, including performance feedback to physicians, enrollee outreach, and community events. Biweekly stakeholder meetings supported data sharing and iterative strategy refinement.

Using Medicaid claims data and a case-finding algorithm aligned with US Preventive Services Task Force (USPSTF) 2021 guidelines, the study compared outcomes in 2 cohorts: a pre-initiative group from 2021–2022 and the initiative group from 2022–2023. Eligible adults were aged 45 to 75 years and continuously enrolled in Medicaid for the prior 12 months.

The number of enrollees up to date with CRC screening rose from 87,914 (46.9%) in 2021 to 98 283 (51.3%) in 2022, a statistically significant improvement (P < .001). Screening increases were greatest among adults aged 45 to 65 years, while screening rates declined among those aged 66 to 75 years.

Three managed care plans surpassed the 50% screening threshold, each earning an average of $217 603 in LD relief.

“Targeting financial incentives at managed care plans rather than individual physicians was associated with improvements in population-level CRC screening,” the researchers wrote. “The approach aligned incentives across multiple system levels, promoting operational changes that extended from plans to physicians to patients.”

Researchers cautioned that screening among older adults declined and that the nonrandomized pre-post design limits causal inference. They called for further research to address persistent disparities and assess the long-term sustainability of improvements.

Reference

Hall JM, Mkuu RS, Warren CO, et al. Medicaid payment policy and colorectal cancer screening rates. JAMA Netw Open. 2025;8(7):e2523271. doi:10.1001/jamanetworkopen.2025.23271