University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA.
Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA.
BMC Health Serv Res. 2022 Feb 19;22(1):233. doi: 10.1186/s12913-022-07599-x.
Medicaid community engagement requirements previously received federal approval in 12 states, despite limited data on their impact on enrollees' employment-related activities. Our objective was to assess longitudinal changes in enrollees' employment and student status after implementation of Michigan's Medicaid expansion.
Longitudinal telephone survey of Michigan Medicaid expansion enrollees in 2016 (response rate [RR] = 53.7%), 2017 (RR = 83.4%), and 2018 (N = 2,608, RR = 89.4%) serially assessing self-reported employment or student status. Survey responses were benchmarked against statewide changes in assessed similar low-income adults in the U.S. Census Bureau Current Population Survey. We used mixed models with individual random effects to assess changes in the proportion of enrollees who were employed or students by year.
Most respondents had incomes < 100% FPL (61.7% with 0-35% of the federal poverty level [FPL], 22.9% with 36-99% FPL, and 15.4% with 100-133% FPL), 89.3% had at least a high school diploma/equivalent, and they ranged in age (39.6% age 19-34, 34.5% age 35-50, 25.9% age 51-64). Employment or student status increased significantly among Michigan Medicaid expansion respondents, from 54.5% in 2016 to 61.4% in 2018 (P < 0.001), including among those with a chronic condition (47.8% to 53.8%, P < 0.001) or mental health/substance use disorder (48.5% to 56.0%, P < 0.001). In contrast, the statewide proportion of low-income non-elderly adults who were employed or students did not change significantly (from 42.7% in 2016 to 46.0% in 2018, P = 0.57).
Medicaid expansion, absent a community engagement requirement, was associated with increased employment and related activities. The role of Medicaid in providing safety-net coverage to individuals during times of economic stress is likely to grow.
尽管关于医疗补助社区参与要求对参保者就业相关活动的影响的数据有限，但此前已有 12 个州获得了联邦政府的批准。我们的目的是评估密歇根州医疗补助扩大计划实施后参保者就业和学生身份的纵向变化。
对 2016 年（回应率[RR]为 53.7%）、2017 年（RR 为 83.4%）和 2018 年（N=2608，RR 为 89.4%）的密歇根州医疗补助扩大计划参保者进行了纵向电话调查，连续评估自我报告的就业或学生状况。调查结果与美国人口普查局当前人口调查中评估的类似低收入成年人在全州范围内的变化进行了基准比较。我们使用具有个体随机效应的混合模型来评估参保者中每年就业或学生的比例变化。
大多数受访者的收入低于 100%联邦贫困线（61.7%的人收入在联邦贫困线的 0-35%之间，22.9%的人收入在 36-99%之间，15.4%的人收入在 100-133%之间），89.3%至少拥有高中文凭/同等学历，年龄范围在 19-34 岁（39.6%）、35-50 岁（34.5%）和 51-64 岁（25.9%）之间。密歇根州医疗补助扩大计划的参保者的就业或学生身份显著增加，从 2016 年的 54.5%增加到 2018 年的 61.4%（P<0.001），包括患有慢性病的人（从 47.8%增加到 53.8%，P<0.001）或心理健康/物质使用障碍（从 48.5%增加到 56.0%，P<0.001）。相比之下，全州范围内的低收入非老年成年人中就业或学生的比例没有显著变化（从 2016 年的 42.7%到 2018 年的 46.0%，P=0.57）。
没有社区参与要求的医疗补助扩大计划与就业和相关活动的增加有关。在经济压力时期，医疗补助为个人提供安全网覆盖的作用可能会增加。
