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MICHIGAN, U.S.: The role Medicaid plays in the broader community is a topic that evokes a lot of emotion across a wide range of fields. With five states set to expand Medicaid in 2019 and 14 potentially requiring Medicaid enrollees to work in return for their health coverage, a new study may help in assessing the pros and cons of such a decision.
Lead by researchers from the University of Michigan (U-M) Institute for Healthcare Policy and Innovation, the research team conducted telephonic surveys with 4,090 participants of a representative sample of Healthy Michigan Plan enrollees to collect the required data for the study. Additionally, the survey also included more comprehensive interviews with 67 participants, in 2015 and 2016, who described the impact of their coverage in more detail.
“What's interesting is that people reported palpable impacts on their health so quickly—usually this can take years to happen,” said Assistant Professor of Internal Medicine at U-M Dr. Renuka Tipirneni, the lead author of the study.
According to the survey’s results, of those who were employed, more than two-thirds of the participants said that having Healthy Michigan Plan coverage had helped them at work and more than a third of those who had changed jobs in the last year said the coverage helped them get a better job. Those who said their health improved due to their new coverage were also four times more likely to say that they were doing a better job at work. Those who had a chronic condition were more likely to say that they were doing a better job at work since getting covered.
The data for low-income earners showed that 80 per cent of those surveyed had incomes below the federal poverty level for their household at the time they took the survey in 2016—which was equivalent to about US$12,000 a year for an individual at the time. The rest had incomes less than 133 per cent of the federal poverty level, which varies depending on household size. Even those working close to full-time at minimum wage may qualify for the Healthy Michigan Plan.
A quarter of the respondents were out of work when they took the telephone survey, yet more than half of them said that their Healthy Michigan Plan coverage improved their ability to look for a job. According to the research, those who were 51-years-old and over were especially likely to say this.
The researchers believe their findings have implications for states, such as Virginia, Utah and Idaho that are set to expand their Medicaid programs in 2019, and for states that have sought permission from the federal Centers for Medicare & Medicaid Services to add a work or community engagement requirement to their existing Medicaid expansion program.
“Our survey shows that a large portion of enrollees who have chronic illnesses or poor health are already working—this has many implications for the way we structure Medicaid programs,” explained Tipirneni. “Proponents of work requirements have stated they are looking for a positive impact on society by encouraging people to work or contribute to society in other ways. What we’re seeing from our data is that this new insurance coverage itself is having positive effects on enrollees’ health and work.”
Arkansas was the first state to require Medicaid expansion enrollees to document that they were working or engaged in other activities. Recent data suggests that failure to meet the program’s work-hour reporting requirements resulted in thousands of enrollees losing their coverage. With Michigan and other states asking for permission to require some or all Medicaid enrollees to work, Tipirneni noted that, “we hope that states can use data from this and prior studies to consider the potential costs and benefits of work requirements in Medicaid.”
Tipirneni and her colleagues recently published recommendations in the New England Journal of Medicine about how states could design such programs without creating undue risk that people with chronic illnesses would lose continuous coverage, and to help healthcare providers navigate their role in documenting which patients should be medically exempt from a work requirement.
The study, titled “Changes in health and ability to work among Medicaid expansion enrollees: A mixed methods study”, was published on Dec. 5 in the Journal of General Internal Medicine.
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