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Expanding Medicaid means chronic health problems get found and health improves, study finds

Those in Michigan's expanded Medicaid program reported not only better physical health, but better mental health outcomes as well.

Jeff Lagasse, Associate Editor

Nearly one in three low-income people enrolled in Michigan's expanded Medicaid program discovered they had a chronic illness that had never been diagnosed before, found a team from the University of Michigan Institute for Healthcare Policy and Innovation..

And whether it was a newly found condition or one they'd known about before, half of Medicaid expansion enrollees with chronic conditions said their overall health improved after one year of coverage or more. Nearly as many said their mental health had improved.

The team's analysis looked at common chronic diagnoses such as diabetes, high blood pressure, depression and asthma -- the kinds of conditions that can worsen over time if not found and treated. Left untreated or under-treated for years, they can heighten risks for costly health crises such as heart attack, stroke, kidney failure, blindness and suicide.

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The University of Michigan team tallied data from a representative sample of 4,090 people who had been covered by the Healthy Michigan Plan for at least a year, and compared them with a similar population of Michigan residents. They also conducted in-depth interviews with a diverse group of 67 people who had been enrolled in the program at least six months.


The findings suggest that low-income people enrolled in expanded Medicaid are now getting care that could prevent complications later in life, thereby reducing overall healthcare costs and utilization. The interviews revealed that many knew they should be getting such care but couldn't afford it.

The message is clear both for states that have opted to expand Medicaid and those that are considering it: The programs have to be prepared to provide a lot of care for untreated or newly diagnosed chronic conditions. Meeting that challenge will likely result in health improvements.

In all, 68% of those surveyed had at least one chronic health condition, 58% had two or more, and 12% had four or more. Of those with a chronic condition of any kind, 42% said it had been identified after their enrollment in the Healthy Michigan Plan.

The researchers found that more than a third of those with diabetes or serious chronic lung disease said it had been diagnosed since they enrolled. So had one-third of those who said they had high blood pressure or heart disease, and nearly a third of those with depression, anxiety or bipolar disorder.

Two-thirds of those who said their condition was newly diagnosed had been uninsured in the year before they enrolled.

Those with chronic conditions were more likely to be white and have very low incomes, less than one-third the federal poverty level. In the year of the study, the poverty level was an annual income of $11,880 for an individual, and individuals making up to $16,394 qualified for Healthy Michigan Plan.


Knowing about a diagnosis is only the first step in managing a chronic condition, researchers said.

Getting access to appointments with health providers, medicines and other treatments and support services is also important. Two-thirds of those with chronic conditions said their access to prescription drugs had improved. Ninety percent had seen a primary care physician within a year after enrolling.

While studies of other states' expansion programs haven't found signs of improved health and access to care until two to four years after Medicaid expansion, this one found signs that this was already happening over an even shorter time period in Michigan.

In all, 52% of those with chronic conditions said their physical health had improved, and 43% said their mental health had improved. After the researchers adjusted for other health and demographic factors, those with chronic conditions were nearly twice as likely as other Healthy Michigan Plan participants to say that both types of health had improved.


Washington, D.C. and the five states that first adopted Medicaid expansion saw larger increases in colorectal cancer screening than those states that did not expand Medicaid, found research published in May.

Additionally, Counties in states that expanded Medicaid coverage under the Affordable Care Act had fewer deaths annually from heart disease compared to areas that did not expand Medicaid, according to preliminary research presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2019.

The Affordable Care Act, enacted in 2010, provided federal support for states to expand Medicaid insurance coverage to low-income adults, a group with limited access to preventive services. Five states and the District of Columbia were very early adopters and expanded Medicaid eligibility in 2010-2011. An additional 21 states expanded their Medicaid programs during 2014 and five states expanded in 2015-2016. To date, 37 states including the District of Columbia have expanded Medicaid and 14 have not.

Twitter: @JELagasse

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