Medicaid Expansion Research at U-M

Medicaid Expansion Research at U-M

Click here for reports from IHPI's evaluation of the Healthy Michigan Plan


IHPI Member Publications on Medicaid Expansion in Michigan


Employment Status and Health Characteristics of Medicaid Expansion Enrollees

Tipirneni, R., Goold, S.D., Ayanian, J.Z. (2017). Employment status and health characteristics of adults with expanded Medicaid coverage in MichiganJAMA Internal Medicine, 178(4), 564-567.

  • Nearly half of enrollees in the Healthy Michigan Plan reported being employed or self-employed full or part time.
  • About one in four enrollees said they were out of work. About one in ten enrollees said they were unable to work. Most of those unable to work reported significant barriers to employment. such as poor health, chronic conditions, older age, or functional limitations.


Economic Effects of Medicaid Expansion in Michigan

Miller, S., Hu, L., Kaestner, R., Mazumder, B., Wong, A. (2018). The ACA Medicaid expansion in Michigan and financial health. NBER Working Paper No. 25053.

  • Enrollment in the Healthy Michigan Plan was associated with large improvements in several measures of financial health, including reductions in unpaid bills, medical bills, over limit credit card spending, delinquencies, and public records (such as evictions, judgments, and bankruptcies). These benefits were apparent across several subgroups, although individuals with greater medical need, such as those with chronic illnesses, experience the largest improvements.

Ayanian, J.Z., Ehrlich, G.M., Grimes, D.R., & Levy, H. (2017). Economic effects of Medicaid expansion in Michigan. New England Journal of Medicine, 376(5), 407-410.

  • Additional employment associated with federal Medicaid expansion spending peaked at over 39,000 jobs in 2016 and is projected to support approximately 30,000 jobs in 2021.
  • Increased personal income associated with new employment in Michigan is expected to be relatively stable, at $2.2 billion to 2.4 billion per year.
  • Added economic activity is projected to yield $145-$153 million/year in new state tax revenue.


Primary Care Provider Views and Experiences

Tipirneni, R., Patel, M.R., Kirch, M.A., Goold., S.D. (2018). Cost conversations between primary care providers and patients with expanded Medicaid coverage. Journal of General Internal Medicine, 33(11), 1845-1847.

  • One in five PCPs reported conversations about out-of-pocket medical costs with low-income Medicaid patients. Half of PCPs who had cost conversations reported a resulting change in management, attesting to the value of such conversations for patient-centered care for patients with Medicaid.

Goold, S.D., Tipirneni, R., Kieffer, E., Haggins, A., Salman, C., Solway, E., Szymecko, L., Chang, T., Rowe, Z., Clark, S., Lee, S., Campbell, E.G., Ayanian, J.Z. (2018). Primary care clinicians’ views about the impact of Medicaid expansion In Michigan: A mixed methods study. Journal of General Internal Medicine, 33(8), 1307-1316.

  • PCPs reported improved patient access to care, medication adherence, chronic condition management, and detection of serious illness. Established patients' access did not diminish, possibly due to reported practice changes.


Medicaid Acceptance & Appointment Availability in Primary Care Practices

Tipirneni, R., Rhodes, K.V., Hayward, R.A., Lichtenstein, R.L., Choi, H., Arntson, E.K., Landgraf, J.M., & Davis, M.M. (2017). Geographic variation in Medicaid acceptance across Michigan primary care practices in the era of the Affordable Care ActMedical Care Research and Review, 1-18.

  • Geographic regions with lower baseline (<50%) Medicaid acceptance had significant increases in Medicaid acceptance at 4 and 8 months post-expansion, while regions with higher baseline (≥50%) Medicaid acceptance did not experience significant changes in Medicaid acceptance.

Tipirneni, R., Rhodes, K.V., Hayward, R.A., Lichtenstein, R.L., Choi, H., Reamer, E.N., & Davis, M.M. (2016). Primary care appointment availability, wait times, and the importance of non-physician providers during the first year of Medicaid expansion under the Affordable Care ActAmerican Journal of Managed Care, 22(6), 427-431.

  • Medicaid appointment availability that had increased at 4 months remained increased 1 year after expansion.
  • More appointments were scheduled with non-physician providers over time.

Tipirneni, R., Rhodes, K.V., Hayward, R.A., Lichtenstein, R.L., Reamer, E.N., & Davis, M.M. (2015). Primary care appointment availability for new Medicaid patients increased after Medicaid expansion in MichiganHealth Affairs, 34(8), 1399-1406.

  • Appointment availability increased 6 percentage points for new Medicaid patients and decreased 2 percentage points for new privately insured patients following Medicaid expansion.
  • Wait times remained stable at 1–2 weeks for both groups.


Changes in Insurance Coverage Among Hospitalized Non-Elderly Adults

Davis, M.M., Gebremariam, A., & Ayanian, J.Z. (2016). Changes in insurance coverage among hospitalized non-elderly adults after Medicaid expansion in MichiganJournal of the American Medical Association, 315(23), 2617-2618.

  • With implementation of the Healthy Michigan Plan, the proportion of hospitalized non-elderly adult patients who were uninsured decreased 4 percentage points and the proportion with Medicaid coverage increased 6 percentage points.


Impact of Medicaid Expansion on Access to Family Planning Services

Moniz, M., Kirch, M.A., Solway, E., Goold, S., Ayanian, J.Z., Kieffer, E.C., Clark, S.J., Tipirneni, R., Kullgren, J.T., Chang, T. (2018). Association of access to family planning services with Medicaid expansion among female enrollees in Michigan. JAMA Network Open, 1(3), e181627.

  • One-third of women of reproductive age reported better ability to access birth control and family planning services through HMP compared with before enrollment. This suggests that Medicaid expansion is associated with improved access to family planning services, which may enable low-income women to maintain optimal reproductive health.


Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes

Likosky, D.S., Sukul, D., Seth, M., He, C., Gurm, H.S., Prager, R.L. (2018). Association between Medicaid expansion and cardiovascular interventions in MichiganJournal of the American College of Cardiology, 71(9), 1050-1051.

  • Medicaid expansion in Michigan was associated with increased access (volume of services) and equivalent quality for patients receiving cardiovascular revascularization. 

Charles, E.J., Johnston, L.E., Herbert, M.A., Mehaffey, J.H., Yount, K.W., Likosky, D.S., Theurer, P.F., Fonner, C.E., Rich, J.B., Speir, A.M., Ailawadi, G., Prager, R.L., Kron, I.L. (2017). Impact of Medicaid expansion on cardiac surgery volume and outcomesAnnals of Thoracic Surgery, 104(4), 1251-1258.

  • Medicaid expansion in Michigan as compared to Virginia, a nonexpansion state, was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates.


Michigan’s Approach to Medicaid Expansion and Reform

Ayanian, J.Z., Clark, S.J., & Tipirneni, R. (2014). Launching the Healthy Michigan Plan – The first 100 daysNew England Journal of Medicine, 371(17), 1573-1575.

  • The Healthy Michigan Plan launched on April 1, 2014 and reached its projected enrollment for 2014 within the first 100 days. Several factors contributed to rapid early enrollment.
  • Outlines policy questions that Michigan is addressing that may also be relevant to other states that have expanded Medicaid or are considering doing so.

Ayanian, J.Z., (2013). Michigan’s approach to Medicaid expansion and reformNew England Journal of Medicine, 369(19), 1773-1775.

  • By linking Michigan’s Medicaid expansion to market-oriented changes to the program, the governor and legislature created a pragmatic path to link Republican and Democratic health care priorities.
  • Outlines five core principles in Michigan’s approach to expand Medicaid under the ACA, including: 1) the state must achieve sufficient savings to offset its contributions for the Medicaid expansion when federal funding drops; 2) financial incentives for program enrollees to control their use of health care services and maintain healthy behaviors; 3) use of Medicaid managed care plans rather than fee-for-service; 4) requirement that enrollees have access to primary care and preventive services; and 5) opportunities to enhance the state’s capacity to monitor the costs and quality of health care.


IHPI Member Publications on Medicaid Expansion Nationally

Levine, D.A., Burke, J.F., Shannon, C.F., Reale, B.K., Chen, L.M. (2018). Association of medication nonadherence among adult survivors of stroke after implementation of the US. Affordable Care Act. JAMA Neurology. Published online August 27, 2018.

Ayanian, J.Z., Tipirneni, R., Goold, S.D. (2018). Mitigating the risks of Medicaid work requirements. New England Journal of Medicine, 379(9), 803-805.

Miller, S. & Wherry, L.R. (2017). Health and access to care during the first 2 years of the ACA Medicaid expansionsNew England Journal of Medicine, 36(10), 947-956.

Nikpay, S., Freedman, S., Levy, H., & Buchmueller, T. (2017). Effect of the Affordable Care Act Medicaid expansion on emergency department visits: Evidence from state-level emergency department databasesAnnals of Emergency Medicine, 70(2), 215-225.

Desmond, B.S., Laux, M.A., Levin, C.C., Huang, J., & Williams, B.C. (2016). Reasons why individuals remain uninsured under the Affordable Care Act:  Experiences of patients at a student-run free clinic in Michigan, a Medicaid expansion stateJournal of Community Health, 41(2), 417-423.

Hu, L., Kaestner, R., Mazumder, B., Miller, S., & Wong, A. (2016). The effect of the Patient Protection and Affordable Care Act Medicaid expansions on financial well-beingThe National Bureau of Economic Research.

Kullgren, J. T. (2016). Injecting facts into the heated debates over Medicaid expansionAnnals of Internal Medicine, 164(12), 848-849.

Lipton, B. J., Wherry, L.R., Miller, S., Kenney, G.M., & Decker, S. (2016). Previous Medicaid expansion may have had lasting positive effects on oral health of non-hispanic black childrenHealth Affairs, 35(12), 2249-2258.

Nikpay, S., Buchmueller, T., & Levy, H.G. (2016). Affordable care act Medicaid expansion reduced uninsured hospital stays in 2014Health Affairs, 35(1), 106-110.

Wherry, L.R., & Miller, S. (2016). Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansionsAnnals of Internal Medicine, 164(12), 795-803.

Giladi, A.M., Aliu, O., & Chung, K.C. (2015). The effect of Medicaid expansion on delivery of finger and thumb replantation care to Medicaid beneficiaries and the uninsuredPlastic and Reconstructive Surgery, 138(5), 640e-647e.

Giladi, A.M., Chung, K.C., & Aliu, O. (2015). Changes in use of autologous and prosthetic postmastectomy reconstruction after Medicaid expansion in New York StatePlastic and Reconstructive Surgery, 135(1), 53-62.

Nikpay, S., Buchmueller, T., & Levy, H. (2015). Early Medicaid expansion in Connecticut stemmed the growth in hospital uncompensated careHealth Affairs, 34(7), 1170-1179.

Aliu, O., Auger, K.A., Sun, G.H., Burke, J.F., Cooke, C.R., Chung, K.C., & Hayward, R. A. (2014). The effect of pre-Affordable care act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical careMedical Care, 52(9), 790-795.

Giladi, A.M., Aliu, O., Chung, K.C. (2014). The effect of Medicaid expansion in new york state on use of subspecialty surgical procedures by Medicaid beneficiaries and the uninsuredJournal of the American College of Surgeons, 218(5), 889-897.

Jones, D.K., Singer, P.M., & Ayanian, J.Z. (2014). The changing landscape of Medicaid practical and political considerations for expansionJournal of the American Medical Association, 311(19), 1964-1966.

Waits, S.A., Reames, B.N., Sheetz, K.H., Englesbe, M.J., & Campbell, D.A. (2014). Anticipating the effects of Medicaid expansion on surgery careJAMA Surgery, 149(7), 745-747.

Lyon, S.M., Douglas, I.S., Cooke, C.R. (2014). Medicaid expansion under the affordable care act: Implications for insurance-related disparities in pulmonary, critical care, and sleepAnnals of the American Thoracic Society, 11(4), 661-667.

Chang, T., & Davis, M.M. (2013).Potential adult Medicaid beneficiaries under the patient protection and Affordable Care Act compared with current adult Medicaid beneficiariesAnnals of Family Medicine, 11(5), 406-411.