Michigan Sate House. Credit: Google Street View
Michigan's decision to expand Medicaid has paid dividends for both patients and primary care providers in the state, with residents experiencing better access to care and the ability to live and work independently, and physicians seeing a higher volume of patients in their practices.
Those are the findings in a new survey published in the Journal of General Internal Medicine by a team from the University of Michigan Institute for Healthcare Policy and Innovation. The results come from 2,104 primary care doctors, nurse practitioners and physician assistants who care for 12 or more people insured by the Healthy Michigan Plan, Michigan's expansion of the Medicaid insurance program to low-income adults.
Of the participating providers, 56.2 percent reported an increase in patients who were seeing a doctor or other healthcare provider for the first time in years, while 57 percent had hired additional office staff, and 53 percent had hired additional clinicians.
Nearly 56 percent said they had consulted with a professional who specializes in connecting high-need and underserved people to care and social services, either a case manager, a care coordinator or a community health worker, and 52.3 percent said they'd seen an increase in their number of new patients.
Despite the findings, provider relationships to Medicaid have been a bit tricky since Medicaid pays reimbursement rates that are lower than Medicare or commercial insurance. The Affordable Care Act gave states federal money to raise Medicaid reimbursement rates, and after those funds ran out, 15 states continued to pay doctors more to give primary care doctors the incentive to accept Medicaid patients, according to the Pew research center.
But over half of the physicians in the survey said they were seeing patients with Medicaid coverage who had previously come to them with no insurance and were responsible for paying for their care out-of-pocket.
About 51 percent said that patients they'd seen before who had lacked insurance or paid directly for their care had gained insurance, while 15 percent said their primary care site had begun offering mental health services. And just under 16 percent said that their existing patients had experienced a decrease in their ability to get a same-day or next-day appointment because of the increase in patients covered by the Healthy Michigan Plan.
More states have been expanding Medicaid, as it has been linked to a number of health and economic benefits over the past few years. Recently, the Virginia legislature voted to expand Medicaid, joining 32 states and Washington D.C. in accepting federal dollars to do so under the Affordable Care Act. The decision comes as the Trump administration and many congressional Republicans seek to shrink the program through repeals, spending caps and block grants, or through work requirements and other waivers to limit eligibility.
Michigan residents are feeling the positive effects of expansion, the survey showed, even improving things such as medication adherence. Of the physicians surveyed, 69 percent said that patients stuck to their medication better because of their new insurance coverage. Meanwhile, 56.5 percent said their patients had improved their health-related behaviors. The Healthy Michigan Plan offers incentives such as gift cards and discounts to encourage participants to stop smoking, exercise more and engage in other healthy behaviors.