Medicaid Expansion Linked to Improved Health and Employment Gains
Recent federal legislation has mandated that the 40 states which have expanded Medicaid under the Affordable Care Act must begin implementing work requirements in their Medicaid programs by January 2027. However, a new study from the University of Michigan suggests that these requirements may have unintended consequences.
The work requirements mean that individuals with low incomes must prove they are working or have a valid reason for not working in order to maintain their Medicaid health coverage. Failure to meet deadlines or provide the necessary information could result in losing access to healthcare.
The study reveals that Medicaid coverage itself is associated with increased employment among those who are least likely to have jobs, specifically individuals with low incomes and significant health issues. Furthermore, improvements in health among Medicaid enrollees are closely linked to gains in employment.
The research found that employment nearly doubled among Medicaid enrollees who initially had significant health problems but experienced improvements in their health. By the end of the study period, 47% of these individuals were employed either full- or part-time, compared to 26% at the beginning of the study.
Among those with moderate or substantial health burdens, 38% of enrollees who were unemployed in 2016 but reported improved health had secured jobs by 2018. This is in contrast to only 14% of individuals whose health remained unchanged or worsened during the same timeframe.
The study also highlighted employment gains among Medicaid enrollees with medium and low levels of total health burdens. However, most individuals in these groups were already employed or self-employed, either full- or part-time.
Published in JAMA Health Forum, the findings are based on a long-term evaluation of Michigan’s Medicaid expansion conducted by the U-M Institute for Healthcare Policy and Innovation. The study involved more than 4,000 enrollees in the Healthy Michigan Plan, which provides coverage to over 716,000 Michigan residents with incomes up to 133% of the poverty level.
Lead author of the study, Minal Patel, Ph.D., emphasized that Medicaid expansion does not discourage work but rather makes it more feasible by improving health outcomes and enabling individuals to participate more fully in the workforce.
The enactment of work requirements in states with expanded Medicaid programs could potentially lead to millions of Americans losing their Medicaid coverage. The study serves as a critical reminder of the intricate relationship between health, employment, and access to healthcare, underscoring the importance of policies that support positive outcomes in all three areas.
