In late 2013, Michigan legislators approved a unique model for the expansion of Medicaid coverage in the state under the Affordable Care Act, called the Healthy Michigan Plan.
Effective April 1, 2014, the Healthy Michigan Plan (Public Act 107 of 2013) expanded the eligibility for Michigan’s Medicaid program to previously uninsured adults with incomes up to 133% of the Federal Poverty Level – about $16,000 per year for a single adult.
The central objective of the Healthy Michigan Plan is to improve the health and well-being of Michigan residents by extending health care coverage to low-income adults who are uninsured or underinsured. The program also introduces a number of reforms, including cost-sharing for individuals with incomes above the Federal Poverty Level, the creation of individual MI Health Accounts to record health care expenses and cost-sharing contributions, and opportunities for beneficiaries to reduce their cost-sharing by completing health risk assessments and engaging in healthy behaviors.
Because the legislation contains reforms to the State’s existing Medicaid program, the federal government requires an independent evaluation of certain components of the program.
In late 2014, the U-M Institute for Healthcare Policy and Innovation (IHPI) received the official state contract from the Michigan Department of Health and Human Services to evaluate the Healthy Michigan Plan's impact on the health of Michiganders and the state's health care system. IHPI has assembled an interdisciplinary team of 17 University of Michigan faculty members across multiple schools and departments, led by IHPI director John Z. Ayanian, M.D., M.P.P.
IHPI is working with MDHHS over the 5-year demonstration period to provide periodic interim evaluation findings and will develop a final report at the end of the demonstration period in 2019.
This evaluation is examining the following seven domains, as outlined in the Healthy Michigan Plan Section 1115 Demonstration Waiver approved by the federal Centers for Medicare and Medicaid Services (CMS):
- The extent to which the increased availability of health insurance reduces the costs of uncompensated care borne by hospitals;
- The extent to which availability of affordable health insurance results in a reduction in the number of uninsured individuals who reside in Michigan;
- Whether the availability of affordable health insurance, including coverage for preventive and health and wellness activities, will increase healthy behaviors and improve health outcomes;
- The extent to which beneficiaries believe that the Healthy Michigan Plan has a positive impact on personal health outcomes;
- Whether requiring beneficiaries to make contributions toward the cost of their health care results in dropped coverage, and whether collecting an average co-pay from beneficiaries in lieu of copayments at the point of service affects beneficiaries’ propensity to use services; and
- Whether providing a MI Health Account into which beneficiaries’ contributions are deposited, that provides quarterly statements detailing utilization and contributions, and allows for reductions in future contribution requirements, deters beneficiaries from receiving needed health services or encourages beneficiaries to be more cost-conscious.
- Whether the evidence about the costs and effectiveness of the Marketplace Option demonstrates cost effectiveness taking into account both initial and longer term costs and other impacts such as improvements in service delivery and health outcomes as compared to the Healthy Michigan Plan.
In addition, IHPI members and local partners have pursued other research, and held scholarly events, related to the Healthy Michigan Plan and the Medicaid expansion nationally. Additional funding from federal and foundation sources supports some of this work.
Healthy Michigan Voices Survey
One of the components of the CMS approved evaluation is the Healthy Michigan Voices survey. Healthy Michigan Voices is a chance for people currently and formerly enrolled in the Healthy Michigan Plan to share their experiences with the Healthy Michigan Plan.
Each month, a group of Healthy Michigan Plan members will be invited to participate; those individuals choose whether they wish to take part.
The telephone survey takes about 20 minutes to complete and participants receive a $25 gift card. Individual survey answers are kept confidential; the University of Michigan will provide a summary of the responses from all people who take part in the survey to the state.
The survey will be conducted in 2016, 2017, and 2018.
Report on Uncompensated Care and Insurance Rates
IHPI, in collaboration with the Michigan Department of Health and Human Services, also prepares a yearly report on uncompensated care and insurance rates.
- Baseline Reports on Uncompensated Care and Insurance Rates (completed December 2014)
- 2014 Report on Uncompensated Care and Insurance Rates (completed December 2015)
- 2015 Report on Uncompensated Care and Insurance Rates (completed December 2016)
- Uncompensated care by hospital2013-2015 (partial data for FY2015) Appendix C of 2015 Report
News stories and publications about our effort and findings:
Most who enrolled in Michigan’s Medicaid expansion either already work or can’t work, study shows (JAMA Internal Medicine, December 2017)
Medicaid Expansion Helped Enrollees Do Better at Work or in Job Searches (Presentation at AcademyHealth 2017 Annual Research Meeting)
Uninsured emergency department visits down after Medicaid expansion (Study in Annals of Emergency Medicine by a U-M/Vanderbilt team of data from 25 states)
Michigan Heart Surgery Outcomes Improved After Medicaid Expansion, Study Finds (Analysis by U. Virginia & U-M team of data from Virginia and Michigan, June 2017)
Medicaid expansion boosts access, reduces cost for poor (Analysis of data from the National Health Interview Survey, March 2017)
Unpaid bills & charity care dropped by nearly half at Michigan hospitals soon after Medicaid expanded (Summary of findings from the 2015 Report on Uncompensated Care and Insurance Rates, January 2017)
Medicaid expansion boosts Michigan’s economy and will more than pay for itself, IHPI study finds (Results from a Commonwealth Fund-supported economic impact study published in NEJM in January 2017)
How the Healthy Michigan Plan Helps Patients and Providers (Blue Cross Blue Shield of Michigan blog post, September 2016)
Rapid Medicaid expansion in Michigan didn’t reduce access to primary care (American Journal of Managed Care, June 2016)
Medicaid expansion significantly boosts insurance coverage among low-income adults (Annals of Internal Medicine paper and editorial, April 2016)
Fast & sharp: Medicaid expansion gives hospitals immediate relief from uninsured care, study finds (Health Affairs, January 2016)
Medicaid Expansion In Michigan: The Second CMS Waiver (Health Affairs blog) January 2016
The Medicaid Expansion Experience In Michigan August 2016
The Healthy Michigan Plan Turns One: Ford School of Public Policy Seminar, April 2015 (VIDEO)
Alpena to Zilwaukee: Symposium on the ACA's impact in Michigan, March 2015 (VIDEO)
Announcement of IHPI contract, December 2014
The First 100 Days of Healthy Michigan Plan: IHPI team publishes in New England Journal of Medicine, October 2014
A Middle Road for Medicaid Expansion: JAMA article by IHPI team, April 2014
Michigan's Medicaid Expansion: A Model for Pragmatic, Bipartisan Health Reform?: NEJM Perspective, September 2013