Study: Half of Michigan Medicaid expansion enrollees work
ANN ARBOR — A study released yesterday finds roughly half of those enrolled in Michigan's Medicaid program since its expansion have jobs and another quarter who are unemployed are likely to be in poor health, raising concerns about potential work requirements for enrollees.
Authors of the study by the University of Michigan Institute for Healthcare Policy and Innovation said the findings suggest that such requirements could disrupt health coverage for vulnerable people with chronic health conditions, and states will incur administrative costs of launching such a work requirement effort "to identify and enforce employment for relatively few individuals."
The study, authors said, is the first published report about health and work-related information directly received from enrollees in states that have expanded their Medicaid programs. It's also the first peer-reviewed study from the institute's formal evaluation of the Healthy Michigan Plan.
Medicaid is a health insurance program for low-income individuals and families jointly funded by the federal and state government. Those eligible to receive Medicaid include children, the elderly and people with disabilities.
According to the study based on 2016 surveys of about 4,000 people enrolled in Michigan's program, 49 percent of respondents said they were working full or part-time, with incomes all below 133 percent of the federal poverty level — about $15,800 per individual and $32,300 for a family of four. Of the 28 percent unemployed, a quarter reported having a physical or mental impairment that interfered with their ability to function at least half the days in the prior month.
Michigan has about 2 million people on Medicaid and 665,000 people enrolled in Healthy Michigan.
The Obama administration, which shepherded the federal health care law known as the Affordable Care Act that also expanded Medicaid coverage, had rejected work requirements. But the Trump administration has urged states to consider changes to Medicaid programs to encourage work and independence. A growing number of mainly Republican-led states have asked or plan to ask for work requirements or other waivers to Obama-era Medicaid rolls. A Michigan lawmaker also has introduced a bill.
"The question raised by these data for states is, is it worth the cost to screen and track enrollees when only a small minority isn't working who are potentially able to work?" Renuka Tipirneni, the study's lead author, asked in a release accompanying the report. "Medicaid expansion was designed to cover those who have a gap in their coverage, or jobs that don't offer insurance but don't pay enough to allow someone to afford individual coverage. States considering work requirements should evaluate their potential impact on individuals, and the potential return on expenditures required for enforcement."
The institute's evaluation, paid for by its contract with the Michigan Department of Health and Human Services, is required under a federal waiver that allowed the state to customize its Medicaid expansion when it launched in 2014. The study was published in JAMA Internal Medicine.