How Medicaid Expansion Impacted Site of Care, Outcomes in MI

Michigan’s Medicaid expansion effort successfully increased access to a regular care site and improved health statuses for many minorities, but did not impact poor mental health days, a study published in Health Affairs found.

The researchers leveraged telephone survey data gathered in 2016, 2017, and 2018. The study observed the impact of Medicaid expansion on health equity for ethnic minorities in Michigan including African American, Hispanic, Arab or Chaldean populations, and those who identified as “other” or “more than one.” The surveys were conducted in English, Spanish, and Arabic.

Before Michigan expanded its Medicaid program, 74.4 percent of respondents indicated that they did not have a regular source of healthcare. 

At the time, nearly half of the respondents indicated that their regular source of care was a doctor’s office or clinic. Another 23.1 percent said that the emergency department, urgent care, or a walk-in clinic provided their regular care.

However, in 2016, 2017, and 2018 after the state implemented Medicaid expansion, the racial and ethnic minorities studied in the report reported having a regular source of care. Overall, more than nine in ten of the respondents—including White individuals—said that they had a regular source of care during the study’s timeframe.

The group that saw the biggest increase in obtaining a regular source of care was the population of respondents that identified as White individuals. Those who identified as Hispanic individuals saw the second-highest increase.

The only group that saw a slightly lower tendency to access a regular source of care was the population of respondents that identified as “other” or “more than one.” In 2016, 88.5 percent of respondents in this group said they had a stable source of care. The next year, 99.1 percent had a stable source of care, but in the final year of the study that dropped to 87.5 percent.

Moreover, regular care may have shifted away from the emergency departments, urgent care centers, and walk-in clinics to more cost-effective sites of care. 

In the year after Michigan expanded Medicaid, 88 percent of respondents reported that a provider’s office or clinic was their regular site of care. This dropped to 83 percent over the course of the next couple of years. Still, the vast majority of respondents were going to more cost-effective sites for their regular care needs.

“In 2018 Hispanic enrollees with a regular source of care increasingly reported that it was an emergency department, urgent care clinic, or walk-in clinic. Nonetheless, identifying any regular source of care and a doctor’s office or clinic as the place of regular source of care was largely sustained in 2017 and 2018 relative to pre-Healthy Michigan Plan levels,” the report noted.

The researchers also noted a shift in health status after the state expanded its Medicaid program.

Most of the populations that the report studied saw an improvement in health status after Medicaid expansion. The Hispanic population in particular experienced a boost with 17.6 percent reporting that they were in fair or poor health in 2018, as opposed to 30 percent in 2016. African American and White respondents also reported improvements.

However, the Chaldean American or Arab American populations had a slight increase in individuals reporting poor or fair heath status over the study’s timeframe.

All populations reported a decrease in poor health days or, in the case of the Arab American and Chaldean American communities, a steadily low rate of poor health days. However, the number of poor mental health days saw no change.

"Our findings did not demonstrate that gains for minority populations were greater or less than gains experienced by the White population,” the researchers noted. 

“Nonetheless, an important point to consider is that around 20 percent of our respondents in wave 1 transitioned from traditional Medicaid to the Healthy Michigan Plan. Because we were unable to measure health or access before enrollment, the data presented may be an underestimation of changes over time after people gained insurance coverage.”

Previous studies indicated that minority and low-income groups benefited from Medicaid expansion through employment and academic opportunities.

Research on Medicaid expansion remains necessary as several states continue to consider expanding their Medicaid programs. Most recently, Missouri’s controversial Medicaid expansion plan pushed through the final legal barriers to become law.

The Biden Administration continues to promote Medicaid expansion as a way for states to increase access to care and diminish state spending.