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    Original Investigation
    Health Policy
    July 10, 2020

    Examination of Changes in Health Status Among Michigan Medicaid Expansion Enrollees From 2016 to 2017

    Author Affiliations
    • 1Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
    • 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
    • 3Department of Internal Medicine, University of Michigan, Ann Arbor
    • 4School of Social Work, University of Michigan, Ann Arbor
    • 5US Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, Michigan
    • 6Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
    • 7Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
    • 8Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
    • 9Department of Family Medicine, University of Michigan, Ann Arbor
    • 10Institute for Social Research, University of Michigan, Ann Arbor
    • 11Department of Pediatrics, University of Michigan, Ann Arbor
    • 12Friends of Parkside, Detroit, Michigan
    JAMA Netw Open. 2020;3(7):e208776. doi:10.1001/jamanetworkopen.2020.8776
    Key Points español 中文 (chinese)

    Question  What longitudinal changes in self-reported health status and days of poor health among racial, ethnic, urban/rural, and very-low-income subgroups of enrollees are associated with Medicaid expansion?

    Findings  In this survey study of 3097 respondents, reports of fair or poor health and days of poor physical health decreased over time among enrollees, especially among non-Hispanic black enrollees and those with very low incomes. There were no statistically significant differences in the number of days of poor mental health or the number of days of usual activities missed owing to poor physical or mental health over time.

    Meaning  These findings suggest that within Medicaid expansion, the health of vulnerable populations is improving.


    Importance  Evidence about the health benefits of Medicaid expansion has been mixed and has largely come from comparing expansion and nonexpansion states.

    Objective  To examine the self-reported health of enrollees in Michigan’s Medicaid expansion, the Healthy Michigan Plan (HMP), over time.

    Design, Setting, and Participants  A telephone survey from January 1 to October 31, 2016 (response rate, 53.7%), and a follow-up survey from March 1, 2017, to January 31, 2018 (response rate, 83.4%), were conducted in Michigan, which expanded Medicaid in 2014 through a Section 1115 waiver permitting state-specific modifications. Four thousand ninety HMP beneficiaries aged 19 to 64 years with at least 12 months of HMP coverage and at least 9 months in a Medicaid health plan were eligible to participate. Data were analyzed from April 1 to November 30, 2018.

    Main Outcomes and Measures  Surveys measured demographic characteristics and health status. Analyses included weights for sampling probability and nonresponse. Comparisons between 2016 and 2017 included those who responded to both surveys (n = 3097).

    Results  Of the 3097 respondents to the 2017 follow-up survey, 2388 (77.1%) were still enrolled in HMP (current enrollees) and 709 (22.9%) were no longer enrolled when surveyed (former enrollees). Among all follow-up respondents, a weighted 37.5% (95% CI, 35.3%-39.9%) were aged 19 to 34 years, 34.0% (95% CI, 31.8%-36.2%) were aged 35 to 50 years, and 28.5% (95% CI, 26.7%-30.3%) were aged 51 to 64 years; 53.0% (95% CI, 50.8%-55.3%) were female. Respondents who reported fair or poor health decreased from 30.7% (95% CI, 28.7%-32.8%) in 2016 to 27.0% (95% CI, 25.1%-29.0%) in 2017 (adjusted odds ratio [AOR], 0.66 [95% CI, 0.53-0.81]; P < .001), with the largest decreases observed in respondents who were non-Hispanic black (from 31.5% [95% CI, 27.1%-35.9%] in 2016 to 26.0% [95% CI, 21.9%-30.1%] in 2017; P = .009), from the Detroit metropolitan area (from 30.7% [95% CI, 27.0%-34.4%] in 2016 to 24.9% [95% CI, 21.6%-28.3%] in 2017; P = .001), and with an income of 0% to 35% of the federal poverty level (from 37.6% [95% CI, 34.2%-40.9%] in 2016 to 32.3% [95% CI, 29.1%-35.5%] in 2017; P < .001). From 2016 to 2017, the mean number of days of poor physical health in the past month decreased significantly from 6.9 (95% CI, 6.5-7.4) to 5.7 (95% CI, 5.3-6.0) (coefficient, −6.10; P < .001), including among current (from 7.0 [95% CI, 6.5-7.5] to 5.6 [95% CI, 5.1-6.0]; P < .001) and former (from 6.8 [95% CI, 5.9-7.7] to 5.8 [95% CI, 5.0-6.7]; P = .02) enrollees, those with 2 or more chronic conditions (from 9.9 [95% CI, 9.3-10.6] to 8.5 [95% CI, 7.8-9.1]; P < .001), across all age groups (19-34 years, from 4.3 [95% CI, 3.7-4.9] to 3.0 [95% CI, 2.5-3.5]; P < .001; 35-50 years, from 8.2 [95% CI, 7.3-9.0] to 6.9 [95% CI, 6.1-7.7]; P = .002; 51-64 years, from 9.0 [95% CI, 8.2-9.8] to 7.6 [95% CI, 6.9-8.3]; P = .001), and among non-Hispanic white (from 7.5 [95% CI, 7.0-8.1] to 6.1 [95% CI, 5.6-6.6]; P < .001) and black (from 5.9 [95% CI, 5.1-6.8] to 4.4 [95% CI, 3.6-5.1]; P < .001) respondents. No changes in days of poor mental health or usual activities missed owing to poor physical or mental health were observed.

    Conclusions and Relevance  These findings suggest that HMP enrollees in Michigan have experienced improvements in self-reported health over time, including minority groups with a history of health disparities and enrollees with chronic health conditions.