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.
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.