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Kelly RP, Marcu G, Hardin A, Iovan S, Tipirneni R. Health Navigator Perspectives on Implementation of Healthy Michigan Plan Work Requirements. JAMA HEALTH FORUM 2022; 3:e221502. [PMID: 35977249 PMCID: PMC9187957 DOI: 10.1001/jamahealthforum.2022.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- R. Patrick Kelly
- Michigan Medicine, University of Michigan, Ann Arbor
- Center for Health and Research Transformation, Ann Arbor, Michigan
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor
| | - Amber Hardin
- School of Information, University of Michigan, Ann Arbor
| | - Samantha Iovan
- Center for Health and Research Transformation, Ann Arbor, Michigan
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
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Tipirneni R, Kieffer EC, Ayanian JZ, Patel MR, Kirch MA, Luster JE, Karmakar M, Goold SD. Longitudinal trends in enrollees' employment and student status after Medicaid expansion. BMC Health Serv Res 2022; 22:233. [PMID: 35183170 PMCID: PMC8857876 DOI: 10.1186/s12913-022-07599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicaid community engagement requirements previously received federal approval in 12 states, despite limited data on their impact on enrollees' employment-related activities. Our objective was to assess longitudinal changes in enrollees' employment and student status after implementation of Michigan's Medicaid expansion. METHODS Longitudinal telephone survey of Michigan Medicaid expansion enrollees in 2016 (response rate [RR] = 53.7%), 2017 (RR = 83.4%), and 2018 (N = 2,608, RR = 89.4%) serially assessing self-reported employment or student status. Survey responses were benchmarked against statewide changes in assessed similar low-income adults in the U.S. Census Bureau Current Population Survey. We used mixed models with individual random effects to assess changes in the proportion of enrollees who were employed or students by year. RESULTS Most respondents had incomes < 100% FPL (61.7% with 0-35% of the federal poverty level [FPL], 22.9% with 36-99% FPL, and 15.4% with 100-133% FPL), 89.3% had at least a high school diploma/equivalent, and they ranged in age (39.6% age 19-34, 34.5% age 35-50, 25.9% age 51-64). Employment or student status increased significantly among Michigan Medicaid expansion respondents, from 54.5% in 2016 to 61.4% in 2018 (P < 0.001), including among those with a chronic condition (47.8% to 53.8%, P < 0.001) or mental health/substance use disorder (48.5% to 56.0%, P < 0.001). In contrast, the statewide proportion of low-income non-elderly adults who were employed or students did not change significantly (from 42.7% in 2016 to 46.0% in 2018, P = 0.57). CONCLUSIONS Medicaid expansion, absent a community engagement requirement, was associated with increased employment and related activities. The role of Medicaid in providing safety-net coverage to individuals during times of economic stress is likely to grow.
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Affiliation(s)
- Renuka Tipirneni
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA.
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA.
| | - Edith C Kieffer
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
- School of Social Work, University of Michigan, Ann Arbor, MI, 48109, USA
| | - John Z Ayanian
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
- University of Michigan Gerald R. Ford School of Public Policy, Ann Arbor, MI, 48109, USA
| | - Minal R Patel
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Matthias A Kirch
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
| | - Jamie E Luster
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA
| | - Monita Karmakar
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA
| | - Susan D Goold
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
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Su-En Lee M, Beathard E, Kirch M, Solway E, Lewallen M, Tipirneni R, Patel M, Rowe Z, Goold SD. Self-Reported Health Status Improved For Racial And Ethnic Minority Groups After Michigan Medicaid Expansion. Health Aff (Millwood) 2021; 40:1637-1643. [PMID: 34606344 DOI: 10.1377/hlthaff.2020.02296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Addressing health inequities for racial and ethnic minority populations is challenging. After passage of the Affordable Care Act, Michigan launched its Healthy Michigan Plan, which expanded Medicaid eligibility in the state. Our evaluation of the expansion provided the opportunity to study its impact on racial and ethnic minority groups, including Arab American and Chaldean American enrollees, an understudied population. Using data from telephone surveys collected in 2016, 2017, and 2018, we conducted an analysis to study the plan's impact on access to a regular source of care and health status among racial and ethnic minority groups. More than 90 percent of respondents of all racial and ethnic groups reported having a regular source of care after plan enrollment compared with 74.4 percent before enrollment. Respondents who identified as non-Hispanic White, African American, and Hispanic reported improvements in health status after plan enrollment. Our study demonstrates the potential of health insurance access to narrow health inequities between racial and ethnic groups.
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Affiliation(s)
- Melinda Su-En Lee
- Melinda Su-En Lee is CEO and cofounder of Parcel Health, Inc., in Pittsburgh, Pennsylvania. At the time this work was performed, she was a graduate student in the College of Pharmacy, University of Michigan, in Ann Arbor, Michigan
| | - Erin Beathard
- Erin Beathard is the Medicaid policy lead in the Institute for Healthcare Policy and Innovation, University of Michigan
| | - Matthias Kirch
- Matthias Kirch is the lead data analyst in the Institute for Healthcare Policy and Innovation, University of Michigan
| | - Erica Solway
- Erica Solway is the senior project manager in the Institute for Healthcare Policy and Innovation, University of Michigan
| | - Maryn Lewallen
- Maryn Lewallen was a research area specialist intermediate in the Center for Bioethics and Social Sciences in Medicine, University of Michigan, when this work was performed. She now resides in Lahore, Pakistan
| | - Renu Tipirneni
- Renu Tipirneni is an assistant professor in the Department of Internal Medicine, University of Michigan Medical School, in Ann Arbor, Michigan
| | - Minal Patel
- Minal Patel is an associate professor in the Department of Health Behavior and Health Education, University of Michigan School of Public Health, in Ann Arbor, Michigan
| | - Zachary Rowe
- Zachary Rowe is the executive director of Friends of Parkside, in Detroit, Michigan
| | - Susan D Goold
- Susan D. Goold is a professor in the Department of Internal Medicine, University of Michigan Medical School, and the Department of Health Management and Policy, University of Michigan School of Public Health
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