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Michigan Ag News Headlines
Most in Medicaid Expansion Either Work or Can't Work
Michigan Ag Connection - 01/02/2018

Nearly half of the people who enrolled in Medicaid after it expanded in Michigan have jobs, a new study finds. Another 11 percent can't work, likely due to serious physical or mental health conditions.

About 1 in 4 enrollees are out of work but also are much more likely to be in poor health, according to the findings published in JAMA Internal Medicine by a team from the University of Michigan Institute for Healthcare Policy and Innovation.

The findings, from a detailed survey of more than 4,000 people enrolled in Michigan's program for more than a year, may inform discussions of potential work requirements for the poor and near-poor Americans who qualify for expanded Medicaid in the 31 states and the District of Columbia that offer it, and other states that are considering expansion.

Several of those states have submitted proposals to require Medicaid expansion enrollees to work at least part time, actively seek work or volunteer, or risk losing Medicaid coverage.

Several others are considering doing so, and the current federal administration has signaled a willingness to approve the waivers states need to enact such requirements. Some states have started voluntary work-referral programs for enrollees.

"The question raised by these data for states is - is it worth the cost to screen and track enrollees when only a small minority isn't working who are potentially able to work," says Renuka Tipirneni, M.D., M.Sc., lead author of the new study and a clinical lecturer in general internal medicine at U-M.

"Even if they don't meet federal disability criteria, our survey shows many of these individuals face significant health challenges," she adds. "It's also important to consider that dropping them from coverage for failure to fulfill a work requirement could seriously impact their ability to receive care for chronic physical and mental health conditions that can worsen without treatment."

The new study is the first published report about work-related information obtained directly from enrollees in Medicaid expansion states, rather than administrative data or survey estimates.

It's also the first peer-reviewed study from IHPI's formal evaluation of Michigan's expansion, called the Healthy Michigan Plan. The evaluation, funded by IHPI's contract with the Michigan Department of Health and Human Services, is required under a federal waiver that allowed the state to customize its Medicaid expansion when it launched in April 2014.

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