Background. Previous work suggests hospitals serving high percentages of patients with Medicaid are associated with worse colon cancer survival. It is unclear if practice patterns in these settings explain differential outcomes. Hypothesis: High Medicaid hospitals (HMH) have lower compliance with evidence-based care processes (examining 12 or more lymph nodes (LN) during surgical staging and providing appropriate chemo-therapy). Methods. Retrospective analysis of stage I–III colon cancers from California Cancer Registry (1996–2006) linked to discharge abstracts and hospital profiles predicted hospital compliance with guidelines and trends in compliance over time. Results. Cases (N=60,000) in 439 hospitals analyzed. High Medicaid hospital settings had lower odds of compliance with the 12 LN exam (ORHMH0.91, CIHMH[0.85, 0.98]) and with the delivery of appropriate chemotherapy (ORHMH0.76, CIHMH[0.67, 0.86]). Conclusions. High Medicaid hospital status is associated with poor performance on evidence-based colon cancer care. Policies to improve the quality of colon cancer care should target these settings.