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    Original Investigation
    Health Policy
    January 31, 2020

    Association of Medicaid Expansion With Enrollee Employment and Student Status in Michigan

    Author Affiliations
    • 1Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
    • 2Department of Internal Medicine, 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
    • 5Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
    • 6School of Social Work, University of Michigan, Ann Arbor
    • 7Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
    • 8Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
    • 9Child Health Evaluation and Research Center, University of Michigan, Ann Arbor
    • 10Institute for Social Research, University of Michigan, Ann Arbor
    • 11Department of Family Medicine, University of Michigan, Ann Arbor
    • 12Department of Emergency Medicine, University of Michigan, Ann Arbor
    JAMA Netw Open. 2020;3(1):e1920316. doi:10.1001/jamanetworkopen.2019.20316
    Key Points español 中文 (chinese)

    Question  Is Medicaid expansion associated with changes in enrollees’ employment or student status?

    Findings  In this survey study of 4090 Michigan Medicaid expansion enrollees conducted after Michigan’s Medicaid expansion, 54.3% of respondents were employed or students in 2016 and 60.0% were employed or students in 2017.

    Meaning  Employment or student status increased among Michigan Medicaid expansion enrollees 2 to 3 years after the state expanded Medicaid and before implementation of community engagement requirements.

    Abstract

    Importance  Medicaid community engagement requirements (work, school, job searching, or community service) are being implemented by several states for the first time, but the association of Medicaid coverage with enrollees’ employment and school attendance is unclear.

    Objective  To assess longitudinal changes in enrollees’ employment or student status after Michigan’s Medicaid expansion.

    Design, Setting, and Participants  This survey study included 4090 nonelderly, adult Healthy Michigan Plan enrollees from March 1, 2017, to January 31, 2018.

    Main Outcomes and Measures  Self-reported employment or student status. Proportionate sampling was stratified by income and geographic region. Mixed-effects regression models with time indicators were used to assess longitudinal changes in the proportion of enrollees who were employed or students.

    Results  The response rate for the initial survey was 53.7% and for the follow-up survey was 83.4%. Of the 3104 respondents to the 2017 follow-up survey (mean [SD] age in 2017, 42.2 [13.0] years; 1867 [53.0%] female), 54.3% were employed or students in 2016, and this number increased to 60.0% in 2017 (percentage point change, 5.7; P < .001). Non-Hispanic black enrollees had significantly larger gains in employment or student status compared with non-Hispanic white enrollees (percentage point change, 10.7 vs 3.5; P = .02). Changes in employment or student status were not associated with improved health status.

    Conclusions and Relevance  Employment or student status increased from 2016 to 2017 among Michigan Medicaid expansion enrollees. These findings provide information about whether Medicaid coverage or community engagement requirements are best to promote the desired outcomes of employment and student status.

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