Michigan’s Medicaid expansion efforts were positively associated with employment and student status among enrollees, according to study data published in JAMA Network Open. These data may prove useful in informing Medicaid’s proposed community engagement requirements.

As of January 2018, the Centers for Medicare & Medicaid Services has begun codifying new community engagement requirements for Medicaid eligibility. Patients must report some form of employment, education, or community service involvement to qualify for Medicaid coverage. The present study evaluated the impact of Medicaid expansion efforts in Michigan for 2016 and 2017, prior to the implementation of the community engagement rule. Known as the Healthy Michigan Project (HMP), Michigan’s Medicaid expansion efforts have provided coverage to 680,000 low-income individuals since 2014. Investigators administered a structured telephone survey to 4090 HMP enrollees between January and October of 2016. A follow-up telephone survey was conducted the following year. Employment, student, and health status were assessed at both points. Demographic characteristics were also extracted, including age, sex, income, and geographic region. Mixed-effects logistic regression models were used to identify longitudinal associations between Medicaid enrollment and employment and student status.

A total of 3104 individuals responded to the initial and follow-up surveys. As of 2017, 76.8% initial respondents were still enrolled in HMP, and 23.2% were no longer enrolled. Mean age in 2017 was 42.2±13.0 years, and 1867 (53.0%) were women. Just more than half had incomes below the federal poverty level, and the majority (80.9%) lived in urban regions. Among all respondents, the proportion reporting employment or student status increased from 54.3% to 60.0% between survey years (P <.001). Among those still enrolled in HMP in 2017, the proportion of those who reported being employed or being students increased from 53.1% to 58.7% (P <.001); among those no longer enrolled in 2017, the proportion increased from 58.2% to 64.1% (P =.002). Improvements in employment and student status were also observed among enrollees with chronic health conditions (6.5% increase; P <.001) and enrollees with mental health or substance use disorders (+6.1%; P <.001). Enrollees who were aged from 35 to 50 years (+8.0%) and from 51 to 64 years (+5.7%), men (+6.7%), non-Hispanic blacks (+10.7%), and those in the lowest income category (+9.2%) reported the greatest increases in employment or student status. Residents of rural regions of Michigan experienced smaller increases in employment or student status compared with other regions. Although substantial gains in HMP enrollee employment and student status were observed, statewide employment and student status trends remained unchanged between 2016 and 2017.

Continue Reading

Related Articles

These data suggest that Medicaid enrollment may have a positive effect on the ability to find and maintain employment, as well as achieve education. The continued expansion of Medicaid could offer low-income residents greater employment and education opportunities, the authors wrote. These results may also have implications for the community engagement requirements and whether such requirements are necessary to improve circumstances for enrollees.


Tipirneni R, Ayanian JZ, Patel MR, et al. Association of Medicaid expansion with enrollee employment and student status in Michigan. JAMA Netw Open. 2020;3(1):e1920316.