Medicaid expansion is linked to improved survival rates in younger colorectal cancer patients with liver metastasis, impacting surgical decision-making.

• 3-year disease-specific mortality dropped from 75% to 68% in expansion states after 6+ years.
• Risk of death reduced by 5-10% in expansion states compared to non-expansion, particularly benefiting those who underwent liver metastasectomy (HR 0.71-0.85).

Access to better multidisciplinary care and systemic therapy may enhance outcomes for patients.

• Only 13.4% of patients had metastasectomy, unaffected by Medicaid status.