Medicaid Expansion May Improve Minority and Low-Income Employment

In Michigan, participants in the Healthy Michigan Plan (HMP), the state’s Medicaid expansion program, saw employment and academic status gains that dwarfed those among the rest of the state’s resident populations especially for certain minority and low-income groups, according to a study by the University of Michigan.

“While on a statewide level, both in the general population and the low-income population, employment levels didn’t change much between 2016 and 2017, we saw a clear increase in employment or student status among those in the Healthy Michigan Plan, even among those with health conditions who we might think would need more time to achieve this,” explained Renuka Tipirneni, MD, the lead author of the new study and an assistant professor of internal medicine at the University of Michigan, in the press release.

The state of Michigan saw barely any change in employment or student population size during the study period. Between 2016 and 2017, the overall employed or academic population size increased by one percentage point. Among low-income Michiganders specifically, it rose less than a single percentage point.

But when stratifying by HMP enrollees, the researchers observed a different picture. HMP enrollees saw significant increases in employment or student enrollment, even among minority populations that have historically had trouble securing employment or academic status gains. 

In particular, non-Hispanic black individuals saw a 10.7 percent rise in employment or academic status between 2016 and 2017. Other groups that saw significant gains in employment or academic status were Michiganders 35 to 50 years of age (8.0 percent change), 51 to 64 years of age (5.7 percent change), men (6.7 percent change), and those with a low income (9.2 percent change).

Michiganders in the state’s rural northern region saw lower increases in employment and academic status. While other areas of the state saw increases as high as 6.2 percent, Northern Michigan saw only a 2.2 percent rise.

“The ability to get access to care, attention for existing or new health issues, and to gain function, appears to have a clear impact on the chances of getting a job or studying or training to get a job later,” summarized Tipirneni.

The study could have implications for the nine states that received approvals from CMS to implement work requirements in their expanded Medicaid programs, not the least of which being Michigan itself.

One limitation was that the study did not include baseline percentages of employment and academic status of Medicaid enrollees from before Medicaid expansion in 2014. Furthermore, while many expansion states look at activities such as job searching, job training, and volunteering as counting toward their community engagement requirement, the study did not cover any of these activities.

The study did not identify the exact means of increased employment and academic status, researchers noted.

“Causal inference could not be determined for this observational study. We assessed statewide temporal trends to provide a benchmark for observed changes in outcomes,” the researchers added.

However, the study did indicate that there was a correlation between HMP and better employment and academic status outcomes.

“Although improvements in ability to work and job seeking associated with improved health were previously reported, it appears that changes in overall employment or student status may have occurred through a different mechanism,” the study explained. “It could be that after obtaining health insurance, which protects against financial losses, enrollees invested greater resources in other areas to improve their success in gaining employment or attending school.”

While the results may not demonstrate a clear delineation of how Medicaid expansion improved enrollees’ employment or academic opportunities, the researchers argued that the results are relevant for states considering implementing a community engagement requirement.

The study is particularly timely for this state. Michigan recently implemented its own work requirement and the decision to do so was an embattled one.

Four middle-aged women who are enrolled in HMP have sued the state saying that the work requirement would pose a threat to their health insurance. According to Michigan Radio, Michigan’s Medicaid officials have also expressed strong concern about the requirement’s potential to disrupt Medicaid enrollees’ coverage. 

Opponents of the requirement cite various studies that show how work requirements can threaten coverage and past examples, particularly in Arkansas where work requirements proved disastrous for the 17,000 Medicaid enrollees who lost their healthcare coverage.

Although the lawsuit is still in process, the work requirements went into effect as planned on January 1, 2020, Michigan Radio confirmed.

The University of Michigan researchers find hope in the employment and academic results that HMP achieved prior to implementing the work requirements.

“Our findings suggest states could achieve goals of fuller employment among low-income residents by expanding Medicaid coverage or maintaining an expansion program,” Susan Goold, MD, the senior author on the new paper and a professor of medicine at the University of Michigan, concluded in the press release. “Good health helps people gain employment or stay employed.”