Fewer Dermatologists Take Medicaid for Skin Cancer Surgery, Study Tracks the Trend

Mohs micrographic surgery is widely regarded as the gold-standard treatment for certain skin cancers, prized for its ability to remove tumors layer by layer while sparing as much healthy tissue as possible. Yet the patients most likely to depend on it may be the least likely to get it. A new research letter published in the Archives of Dermatological Research by Ross O’Hagan, Olivia McGeough, and Jesse M. Lewin of the Icahn School of Medicine at Mount Sinai examines a deceptively simple question with far-reaching consequences: how has physician participation in fee-for-service Medicaid changed over time when it comes to Mohs surgery? The answer, the authors suggest, carries weight for millions of Americans who rely on public insurance for their cancer care.

The study, published on 20 September 2026 as a research letter in volume 318 of the journal, takes advantage of a uniquely transparent data resource. Rather than relying on insurance claims, which are often proprietary and difficult to obtain, the team drew on publicly accessible provider-level data hosted by the U.S. Department of Health and Human Services, specifically the Medicaid provider spending datasets available through the department’s open data portal. Because the analysis used only publicly available provider-level information containing no identifiable patient data, the authors note that institutional review board approval was not required, and the work was conducted in accordance with the Declaration of Helsinki and its subsequent amendments.

The technical logic behind the approach is worth unpacking. Medicaid, the joint federal-state health insurance program, operates differently across states, and a substantial share of beneficiaries are enrolled in managed care plans rather than traditional fee-for-service arrangements. Fee-for-service data, in which providers bill the program directly for each service rendered, offer a consistent signal of whether a given physician is actually treating Medicaid patients. By tracking participation among surgeons who perform Mohs micrographic surgery, identified through billing for the procedure, the researchers could construct a picture of access trends over time, capturing whether the pool of surgeons willing to accept Medicaid beneficiaries is shrinking, growing, or holding steady.

Why does this matter clinically? Mohs micrographic surgery is a tissue-sparing technique most often used for nonmelanoma skin cancers, particularly basal cell carcinoma and squamous cell carcinoma located on high-risk areas such as the face, ears, and hands. The procedure involves the sequential removal of thin layers of tissue, each examined microscopically at the bedside while the patient waits, allowing the surgeon to map exactly where tumor cells remain. This real-time margin assessment maximizes cure rates while minimizing the removal of healthy tissue, which is why it is favored for tumors in cosmetically and functionally sensitive sites. Skin cancer is among the most common cancers in the United States, and access to this procedure is therefore not a niche concern but a mainstream issue in oncologic dermatology.

The new study does not stand in isolation. It builds on a growing body of literature documenting disparities in dermatologic care for Medicaid beneficiaries. Prior work cited by the authors includes a 2020 study in the Journal of the American Academy of Dermatology by Mazmudar and colleagues, which compared dermatologist appointment access and waiting times across insurance types and found that Medicaid patients faced meaningful barriers to securing care. A 2023 study by Sharma and colleagues examined nonmelanoma skin cancer and the utilization of Mohs micrographic surgery specifically among Medicaid patients, highlighting questions about whether this population receives guideline-concordant surgical treatment at the same rate as privately insured patients.

Perhaps most directly relevant is a 2023 analysis by Beltrami, Hooper, Kodumudi, and colleagues, also published in the Journal of the American Academy of Dermatology, which investigated the association between state-specific reimbursement rates and Medicaid acceptance for Mohs micrographic surgery. That work pointed toward a familiar economic mechanism: when states pay less for a procedure, fewer specialists are willing to accept that insurance. A companion 2022 study by the same group characterized the physicians who do accept Medicaid for Mohs surgery, beginning to sketch a profile of the provider workforce serving this population. The new research letter extends this line of inquiry from static snapshots to longitudinal trends, asking not just who accepts Medicaid today but how participation has shifted across the recent past.

The workforce dimension adds another layer of urgency. A 2025 cross-sectional analysis by Ahn, Yu, Scott, and colleagues sought to define the Mohs micrographic surgery workforce itself, using billing data for the primary tissue-processing code from 2015 to 2020 to estimate how many surgeons perform the procedure nationally. Understanding the size and distribution of that workforce is a prerequisite for understanding access: if the number of Mohs surgeons is limited and only a fraction accept Medicaid, the effective supply of care available to beneficiaries may be far smaller than headline counts of providers suggest. The Mount Sinai team’s trend analysis speaks directly to this concern by measuring the dynamic component, participation, rather than the static component, headcount.

Methodologically, the study is a research letter, a compact format that journals use to disseminate timely findings without the full apparatus of an original article. The authors report that all three contributed to writing the manuscript, with O’Hagan preparing the two figures that accompany the letter. The team declared no conflicts of interest and reported no external funding, and the corresponding author is Lewin, whose department, the Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, sits at the intersection of clinical practice and health services research in New York City, a market where insurance dynamics and specialist access are under perpetual scrutiny.

The policy stakes of this line of research are considerable. Medicaid enrollment in the United States has fluctuated dramatically in recent years, swelling during the pandemic-era continuous enrollment period and contracting as states resumed eligibility redeterminations. Each swing shifts the composition of the insured population and, by extension, the demand placed on specialists. If participation in fee-for-service Medicaid among Mohs surgeons is declining even as enrollment rises, the mismatch could translate into longer travel distances, longer waits, or transitions to less tissue-sparing treatments for beneficiaries, outcomes with direct implications for cancer control in a vulnerable population. Reimbursement policy, scope-of-practice debates, and workforce training all intersect here, and granular participation data give policymakers a lever for evaluating interventions such as rate increases or network adequacy requirements.

For readers following the science of health equity, the study is a reminder that access to advanced surgical care is shaped as much by administrative and economic structures as by biology. The technique itself, developed decades ago and refined through generations of surgeons, offers cure rates that few oncologic procedures can match. Whether that benefit reaches patients on public insurance depends on datasets like the ones this team mined, on researchers willing to ask unglamorous questions about billing and participation, and on the willingness of states to align reimbursement with the realities of surgical practice. The full article, including the figures charting participation trends, is available in the Archives of Dermatological Research, and the underlying data remain publicly accessible for other investigators to interrogate, replicate, and extend.

Subject of Research: Trends in fee-for-service Medicaid participation among Mohs micrographic surgery providers in the United States

Article Title: Trends in fee-for-service medicaid participation in Mohs micrographic surgery

Article References: Trends in fee-for-service medicaid participation in Mohs micrographic surgery. (n.d.). https://doi.org/10.1007/s00403-026-04876-1

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04876-1

Keywords: Mohs micrographic surgery, Medicaid, dermatology, health policy, skin cancer, healthcare access, insurance participation, health disparities, reimbursement, workforce, fee-for-service, nonmelanoma skin cancer