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Research Letter
Health Care Reform
April 2018

Employment Status and Health Characteristics of Adults With Expanded Medicaid Coverage in Michigan

Author Affiliations
  • 1Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 3Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
  • 4Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
JAMA Intern Med. 2018;178(4):564-567. doi:10.1001/jamainternmed.2017.7055

The Affordable Care Act (ACA) expanded Medicaid coverage to approximately 11 million working-age adults. Critics have raised concerns about providing Medicaid to adults capable of working. Several states have proposed work requirements in Section 1115 Medicaid waivers.1,2 Although none were approved during the Obama administration, the Trump administration is willing to consider such provisions.3 Prior analyses4 estimated that half of adults eligible for ACA Medicaid expansion were employed, and 62% of nondisabled adults were working or in school. Although these national estimates of Medicaid-eligible individuals are valuable, less is known about the employment experience of actual enrollees in Medicaid expansion states and which health characteristics may keep them from working. Complementary state-level analyses are needed as individual states consider whether to propose work requirements. This study examined the demographic and health characteristics associated with the employment status of current Medicaid expansion enrollees in Michigan, which expanded Medicaid under a Section 1115 waiver to nonelderly adults with incomes at or below 133% of the federal poverty level who do not otherwise qualify for Medicaid or Medicare based on disability or other criteria.5

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