LAUSR

minutes, respectively. A higher proportion of Medicare beneficiaries drive less than 30 minutes (77.6%) to reach MMS compared withMedicaid beneficiaries (68.3%), who are consistently overrepresented in driving time intervals $60 minutes (14.6% vs 8.4%) (Figure 1A). Medicaid beneficiaries are also overrepresented in driving distances greater than 15 miles compared with Medicare (48.5% vs 29.3%) (Figure 1B). In 40 of 50 states and District of Columbia, driving time and distance were significantly longer for Medicaid beneficiaries (p , .05), except for distance in Nevada (see Supplemental Digital Content, Figure S1a, b, http://links.lww.com/DSS/B205, which illustrate differences in driving time and driving distance among Medicaid and Medicare beneficiaries by state). Our findings reveal that Medicaid beneficiaries are disproportionately burdened by distance and time traveled to access in-network MMS compared with Medicare beneficiaries in most states. Geographic maldistribution of Mohs surgeons creates access barriers based on state and rurality, and physician Medicaid participation status can further exacerbate these issues. With Medicaid participation among Mohs surgeons already limited in most states, these findings reveal an additional barrier to accessing dermatologic care among Medicaid beneficiaries. Although the clinical significance of differences in national average driving time and distance between Medicaid and Medicare beneficiaries merits further study, it is known that increased distance to oncologic care decreases treatment utilization and increases risk of metastatic disease. Medicaid beneficiaries more commonly lack reliable transportation. Therefore, even a modest obstacle to accessing MMS among transportation-limited patients may hinder care from being obtained. Although increased travel distance or time are unlikely to be the sole variables driving disparities, these factors may perpetuate or exacerbate limited access, underscoring the need to address these barriers. Of note, Medicare beneficiaries experienced greater driving distances in select rural states (e.g., Idaho, Montana,Nebraska,Wyoming),which likely have a smaller density of Mohs surgeons. Study limitations include potential inaccurate capture of insurance acceptance status and inability to assess longitudinal trends or impact of these findings onMMSutilization. The use of population centers through the ArcGIS tool may also limit calculation accuracy by simplifying heterogeneous population distributions within a county. Assuming normal traffic patterns, exclusive use of in-state surgeons and all patients would access MMS by vehicle may also underestimate or overestimate true travel distance or time. Nevertheless, this study quantifies the travel burden ofMedicaid beneficiaries in accessing MMS. Future research is warranted to elucidate the clinical implications of driving distance and time differences to in-network Mohs surgeons.