Michigan's Medicaid expansion has proven successful in expanding healthcare access, according to two new studies.
The findings appear in two papers published in the Journal of General Internal Medicine by several members of the Healthy Michigan Plan (HMP) evaluation team from the University of Michigan (U-M) Institute for Healthcare Policy and Innovation (IHPI).
The studies are based on results from a survey of more than 4,000 Michiganders, out of the more than 1 million who have gotten coverage from the HMP since its launch in 2014. The program currently covers more than 642,000 state residents who make less than about $16,000 a year for an individual, or $33,000 for a family of four. Among those surveyed, over two-thirds are working, going to school, retired or unable to work.
When the state of Michigan expanded its Medicaid program to provide health coverage to more low-income residents, its leaders built special features into the plan, different from most states. They wanted to encourage enrollees to understand their individual health risks, and incentivize them to prevent future health problems, or find them early.
“Customizing Medicaid expansion to emphasize primary care and prevention took extra effort, but appears successful, at least according to the snapshot of enrollees that these data represent,” said Susan Dorr Goold, MD, MHSA, MA, the lead author of one of the two papers and a professor of internal medicine at U-M.
Former IHPI National Clinician Scholar Taylor Kelley, MD, MPH, MSc, now at the University of Utah, notes, “While too early to tell whether the program will lead to sustained behavior change, it is clear more conversations are happening between doctors and patients about lifestyle change, and patients have been surprisingly eager to commit to healthy behaviors.” Kelley is lead author of the other of the two papers.
“The role of primary care providers, and their teams, in helping low-income and working-poor people understand what health risks they face, and encouraging them to modify the risk factors they can change, is crucial,” says Renuka Tipirneni, MD, MSc, senior author of the paper led by Kelley and an assistant professor of internal medicine.
The percentage of enrollees in the Healthy Michigan Plan who saw a primary care doctor in a given year doubled, and many of those visits included a discussion of healthy behaviors that could improve their long-term health, the studies show.
Half of the enrollees said they completed the Healthy Michigan Plan “health risk assessment” questionnaire and went over it with a physician. A majority of enrollees got preventive care, such as cancer screenings or dental visits.
It appears that the special financial incentives that the state built into the program played only a partial role in completion of the health risk assessment. In fact, many of the enrollees didn’t even know they could get a cost-sharing discount by filling it out and discussing it with their doctor.
Goold, Kelley, Tipirneni and many of their co-authors have been part of the IHPI team that is carrying out the official evaluation of the Healthy Michigan Plan for the Michigan Department of Health and Human Services.
The team surveyed 4,090 HMP participants between the ages of 19 and 64 years who had been enrolled in the program for more than a year, using their preferred language of English, Spanish, or Arabic. The survey was carried out in 2016, and claims data were also used to examine enrollees’ use of healthcare services.
Some of their key findings: