Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study

Abstract

Background: Michigan expanded Medicaid under the Affordable Care Act (Healthy Michigan Plan [HMP]) to improve the health of low-income residents and the state’s economy. Objective: To understand HMP’s impact on enrollees’ health, ability to work, and ability to seek employment Design: Mixed methods study, including 67 qualitative interviews and 4090 computer-assisted telephone surveys (response rate 53.7%) Participants: Non-elderly adult HMP enrollees Main Measures: Changes in health status, ability to work, and ability to seek employment Key Results: Half (47.8%) of respondents reported better physical health, 38.2% better mental health, and 39.5% better dental health since HMP enrollment. Among employed respondents, 69.4% reported HMP helped them do a better job at work. Among out-of-work respondents, 54.5% agreed HMP made them better able to look for a job. Among respondents who changed jobs, 36.9% agreed HMP helped them get a better job. In adjusted analyses, improved health was associated with the ability to do a better job at work (aOR 4.08, 95% CI 3.11–5.35, p < 0.001), seek a job (aOR 2.82, 95% CI 1.93–4.10, p < 0.001), and get a better job (aOR 3.20, 95% CI 1.69–6.09, p < 0.001), but not with employment status (aOR 1.08, 95% CI 0.89–1.30, p = 0.44). In interviews, several HMP enrollees attributed their ability to get or maintain employment to improved physical, mental, and dental health because of services covered by HMP. Remaining barriers to work cited by enrollees included older age, disability, illness, and caregiving responsibilities. Conclusions: Many low-income HMP enrollees reported improved health, ability to work, and job seeking after obtaining health insurance through Medicaid expansion.