Key Takeaway
The expansion of Medicaid in Michigan through the Healthy Michigan Plan has provided a reliable source of insurance coverage and access to care for many adults ages 19 to 64 with low incomes and has become a key component of the state’s healthcare system and safety net over the past decade.
Background
In 2013, Michigan legislators approved the expansion of Medicaid coverage under the Affordable Care Act, known as the Healthy Michigan Plan (HMP). HMP began providing coverage to adults with incomes up to 133% of the Federal Poverty Level (FPL) on April 1, 2014, and since then has provided coverage to well over one million Michigan residents. Michigan enacted the expansion through a Section 1115 demonstration waiver from the Centers for Medicare & Medicaid Services (CMS), enabling the state to implement policies related to cost-sharing and healthy behavior incentives not otherwise included in Medicaid under federal law. The Michigan Department of Health and Human Services (MDHHS) and CMS selected an interdisciplinary team of researchers at the University of Michigan Institute for Healthcare Policy & Innovation (IHPI) to conduct an independent evaluation from 2014 to 2024.
Below we highlight key findings on the impact of Medicaid expansion in Michigan and provide some examples which draw on surveys and interviews with enrollees and providers, conversations with other key stakeholders, and analyses of Medicaid administrative data, credit report data, and several publicly available datasets.
Key Findings
1. The number of Michigan residents without health insurance decreased substantially after Medicaid expansion.
HMP resulted in a 6.3 percentage point drop in uninsurance among low-income non-elderly adults.
2. Michigan hospitals provided less uncompensated care after Medicaid expansion.
Hospital uncompensated care in Michigan was reduced by half following HMP implementation.
HMP was associated with an average reduction in uncompensated care of over $5 million per hospital per year.
3. Medicaid expansion enrollees reported improved access to care and increased use of primary care services.
The percentage of enrollees who reported that a doctor’s office or clinic was the place they usually went for health care increased from 50% before enrollment to 87% after enrollment.
4. Medicaid expansion enrollees saw improvements in employment and financial well-being.
- The percentage of enrollees who were employed increased from 2016 to 2018.
- 55% of those who were out of work reported having Medicaid made them better able to look for a job.
- 37% of those who changed jobs in the past year reported having Medicaid helped them get a better job.
- 69% of those who were already working reported that Medicaid helped them do a better job at work.
Medicaid expansion was associated with significant and consistent reductions in medical debt in collections for enrollees up to seven years post-enrollment.
5. Medicaid expansion enrollees used less emergency care over time.
The percentage of enrollees who reported an ER visit in the previous year decreased from 38% in 2016 to 33% in 2021.
6. Medicaid expansion enrollees experienced improved health and overall well-being.
- 48% reported improved physical health
- 38% reported improved mental health
- 40% reported improved dental health
- 88% strongly agreed or agreed that having HMP has taken a lot of stress off them.
Policy Implications
The Healthy Michigan Plan evaluation has informed important policy discussions and decisions in Michigan and throughout the nation and offers insights for Medicaid’s future. The findings can help to inform states as they consider Medicaid expansion or implement new policies for the Medicaid expansion population required by the 2025 federal budget reconciliation bill, such as work requirements, more frequent eligibility determinations, and cost sharing requirements for adults with incomes from 100 to 138% FPL. Evaluations will remain vital to assessing how upcoming policy changes impact enrollees, health care providers, and healthcare systems to ensure that Medicaid continues to improve the health of communities in Michigan and nationwide.
References
For more information about the Healthy Michigan Plan Evaluation, to read the full evaluation reports, and to access other briefs, visit ihpi.umich.edu/featured-work/hmp.
Questions? Reach out to us at [email protected].
