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The percentage of enrollees who saw a primary care doctor in a given year doubled to nearly 90%, and a majority of recipients got preventative care, such as cancer screenings or dental visits.

When Michigan expanded Medicaid to cover more low-income residents in 2014, the state customized its program to emphasize primary care and preventative health services. Nearly six years later, a pair of studies show that this approach has paid off, improving access to care. 

The percentage of enrollees in the state’s Healthy Michigan Plan (HMP) who saw a primary care doctor in a given year doubled to nearly 90% and a majority of recipients got preventative care, such as cancer screenings or dental visits. Enrollees also reported foregoing care due to cost less frequently after receiving coverage through the expansion.

The research—published just weeks before Michigan’s new Medicaid work requirements went into effect requiring able-bodied beneficiaries report at least 80 hours of work or other activities—appeared in the Journal of General Internal Medicine in December. 

“This adds to the evidence that Medicaid expansion improves access to care and the impact of Medicaid expansion on access to preventive and primary care services is something we should take note of,” Dr. Susan Goold, a co-author of the studies, told the American Medical Association (AMA).

Dr. Goold, a professor of internal medicine and health management and policy at the University of Michigan, worked with her colleagues to survey 4,090 Healthy Michigan enrollees between the ages of 19-64. They also analyzed preventive services claims data to produce the studies. 

Using those methods, they found:

  • Nearly 58% of those surveyed lacked health insurance in the year prior to enrolling in HMP. 
  • One out of every five enrollees said they hadn’t been to a primary care doctor in the past five years before gaining HMP coverage. Only about two-fifths had seen a primary care provider in the year preceding enrollment. But in the year after enrollment, nearly 90% saw a primary care provider. 
  • One-third said they had foregone needed care due to cost or lack of insurance in the 12 months before enrollment.
  • 92% said they had a regular source of care since enrolling and the percentage of respondents who said the emergency room or urgent care was that source dropped from 25.3% to 7% after enrollment.
  • 59% said their coverage helped them access prescription drugs and 46% said it helped them access dental care.
  • More than 70% of women over 50 received a breast cancer screening after enrollment and more than half of adults over 50 received a colon cancer screening.
  • Nearly 90% said having coverage through HMP reduced their stress and worry.

“That’s pretty remarkable,” Dr. Goold told the AMA about the improvements. 

The state’s Medicaid expansion placed a particular emphasis on enrollees completing a “health risk assessment,” or HRA. The Healthy Michigan Plan encouraged enrollees to complete HRAs and commit to healthy behaviors and are even eligible for a financial reward—such as a gift card or reduced copay—if they do so. 

While about half of all enrollees completed the HRA and reviewed it with a physician, 72% were unaware of the financial incentives and only 2.5% said they completed the HRA over the monetary reward, according to the studies. Many patients completed the HRA at the suggestion of their primary care doctor. 

Regardless of the reason behind the increase, Goold was pleased that more enrollees were filling out HRAs. She and her colleagues also recommended other states follow Michigan’s lead. 

“Other states should consider ways to encourage the use of primary care to improve the health of low income adults covered by Medicaid,” they wrote in one of the reports. 

More than 640,000 Michiganders currently receive coverage under the HMP, which covers residents in households with incomes up to 138% of the federal poverty line.

A new state law, however, threatens that coverage by requiring some recipients to document regular hours of work, job-training, or volunteering. Between 61,000 and 183,000 residents who obtain care through the Healthy Michigan Plan are expected to lose their health benefits in one year because of these work requirements, which have been blocked in other states due to legal challenges.

“You don’t force people to work to get them healthy,” Leonardo Cuello, director of health policy at the National Health Law Program, told COURIER in a previous interview. “You enable them to be healthy, which enables them to work.”