Montana
Fee-For-Service Medicaid Coverage of Screening
Yes
Highlighted Disparity
Indigenous Peoples in Montana are most likely to be diagnosed with lung cancer.
Lung Cancer Rates
New Cases:
- The rate of new lung cancer cases is 52 and significantly lower than the national rate of 58.
- Montana ranks 11th among all states, placing it in the average tier.
- Over the last five years, the rate of new cases improved by 17%.
5-Year Survival Rate:
- The percent of people alive five years after being diagnosed with lung cancer (the survival rate) in Montana is 23%, which is not significantly different than the national rate of 24%.
- It ranks 25th among the 45 states with survival data, placing it in the below average tier.
- Over the last five years, the survival rate in Montana did not change significantly.
Early Diagnosis:
- 24% of cases are caught at an early stage, which is not significantly different than the national rate of 24%.
- It ranks 32nd among the 49 states with data on diagnosis at an early stage, placing it in the average tier.
- Over the last five years, the early diagnosis rate in Montana improved by 67%.
Lung Cancer Treatment
Surgical Treatment:
- Montana ranked 24th (out of the 49 states with available data) with 19% of cases undergoing surgery as part of the first course of treatment.
- This is not significantly different than the national rate of 20.7% and puts Montana in the average tier.
- Over the last five years, the percent of cases undergoing surgery in Montana did not change significantly.
Lack of Treatment:
- Montana ranked 39th (out of the 49 states with available data) with 24% of cases not receiving any treatment.
- This is significantly higher than the national rate of 21% and puts Montana in the below average tier.
- Over the last five years, the percent of cases receiving no treatment in Montana did not change significantly.
Screening
Screening for High Risk:
- In Montana, 6% of those at high risk were screened, which was not significantly different than the national rate of 6%.
- It ranks 24th among all states, placing it in the average tier.
Medicaid Coverage:
- Montana was one of the 40 states whose Medicaid fee-for-service programs covered lung cancer screening as of September 2021.
- While their program did not require prior authorization or cost sharing, it did not use recommended guidelines for determining eligibility.
Prevention
Tobacco Use:
- The smoking rate in Montana is 17% and not significantly different than the national rate of 15%.
- It ranks 30th among all states, placing it in the average tier.
Radon:
- In Montana, 46% of radon tests results were at or above the action level recommended by EPA.
- It ranks 44th among all states, placing it in the bottom tier.
Racial & Ethnic Disparities
Black Americans:
- Lung cancer rates are not available for Black Americans in Montana due to too few cases over the time period to allow for accurate analysis.
Latino Americans:
- The rate of new lung cancer cases is 30 per 100,000 population among Latinos in Montana, not significantly different than the rate of 29 among Latinos nationally, and significantly lower than the rate of 51 among whites in Montana.
- State-level survival rates are not available for Latino Americans at this time. Nationally, the five-year survival rate among Latino Americans is 19%, 13% lower than among white Americans.
- Other lung cancer rates are not available for Latino Americans in Montana due to too few cases over the time period to allow for accurate analysis.
Asian Americans or Pacific Islanders:
- Lung cancer rates are not available for Asian Americans or Pacific Islanders in Montana due to too few cases over the time period to allow for accurate analysis.
Indigenous Peoples:
- The rate of new lung cancer cases is 97 per 100,000 population among Indigenous Peoples (American Indians/Alaska Natives) in Montana, significantly higher than the rate of 41 among Indigenous Peoples nationally, and significantly higher than the rate of 51 among whites in Montana.
- State-level survival rates are not available for Indigenous Peoples at this time. Nationally, the five-year survival rate among Indigenous Peoples is 19%, 11% lower than among white Americans.
- 17% of lung cancer cases are diagnosed at an early stage among Indigenous Peoples (American Indians/Alaska Natives) in Montana, not significantly different than the rate of 22% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and significantly lower than the rate of 24% among whites in Montana.
- 12% of Indigenous Peoples (American Indians/Alaska Natives) with lung cancer in Montana underwent surgery, significantly lower than the rate of 17% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and significantly lower than the rate of 20% among whites in Montana.
- 25% of Indigenous Peoples (American Indians/Alaska Natives) with lung cancer in Montana did not receive any treatment, not significantly different than the rate of 23% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 24% among whites in Montana.
Summary
Despite the early diagnosis rate in Montana falling into the average tier, the state still has a lot of work to do to make sure that more of those at high risk for lung cancer are screened.
Montana has improved access to screening by covering it through its fee-for-service Medicaid program. The Lung Association encourages all states to cover lung cancer screening based on recommended guidelines across all fee-for-service and managed care plans without any financial or administrative barriers in their Medicaid programs.
It is alarming that Montana falls into the below average tier for percent of patients not receiving any treatment. Some patients do refuse treatment, but issues such as fatalism and stigma can prevent eligible patients from accessing treatment that may save or extend their lives. All patients should work with their doctors to establish a treatment plan and goals.