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As Medicaid ‘unwinding’ continues, what is the impact on health coverage?

Throughout the U.S., states are in the process of “unwinding” the special Medicaid continuous-enrollment provision.

A health care worker prepares to inject a patient with a Covid-19 vaccine
A health care worker prepares to inject a patient with a Covid-19 vaccine - Copyright AFP/File Joseph Prezioso
A health care worker prepares to inject a patient with a Covid-19 vaccine - Copyright AFP/File Joseph Prezioso

This is a pivotal time for Medicaid health coverage for U.S. citizens with low incomes, as some of the progressive gains made during COVID-19 are pulled back. This means health coverage has been cancelled for millions of people.

A new report looks at the specific impacts of Michigan’s Medicaid expansion. This shows positive effects as coverage was extended, together with opportunities for continued improvements. The impact of a reduction on coverage is also considered, both locally and nationwide.

This assessment report was produced by the University of Michigan Institute for Healthcare Policy and Innovation. This assessment forms part of the Healthy Michigan Plan. This program currently has one million enrollees, having been signed into law 10 years ago.

The report shows that the Healthy Michigan Plan has been effective at reducing the number of uninsured individuals and supporting financial well-being. There has also been success at promoting primary care and responsible use of health care services among people with low incomes. The program has also been assessed in sustaining the safety net and supporting coordinated strategies to address social determinants of health.

The new report draws on data and interviews to show the different aspects of Michigan’s expansion. This includes financial incentives for participants, intended to focus on healthy behaviours as well as income-based cost-sharing to foster personal responsibility around health care decisions. These were deemed to be only partially effective at achieving their intended aims.

The findings should have implications beyond Michigan. Throughout the U.S., states are in the process of “unwinding” the special Medicaid continuous-enrollment provision that was put in place during the height of the Public Health Emergency during the COVID-19 pandemic.

During the COVID-19 pandemic, the Healthy Michigan Plan maintained access to coverage and care for those already enrolled and offered coverage for new beneficiaries affected by unemployment and loss of health insurance. This has been subject to change. Since April 2023, some 5.3 million people have lost Medicaid coverage in the 45 states and District of Columbia. These redeterminations of individual eligibility will continue into 2024.

Measuring the impacts of the unwinding on individuals, health systems and safety net agencies continues to be important, especially in light of the positive impacts of expansion coverage.

According to researcher John Ayanian: “Since 2014, the Healthy Michigan Plan has increased access to care and was associated with improved health and other outcomes reported by beneficiaries, many of whom were previously uninsured or unconnected to social support services that can impact health.”

This recently enacted Michigan law modifies some of the income-based cost-sharing requirements of the Healthy Michigan Plan, which the report finds have not fully achieved their aim. The Healthy Michigan Plan is open to Michigan residents ages 19 to 64 who earn an income at or below 138 percent of the federal poverty level—as of 2022, $18,754 for an individual or $36,908 for a family of four.

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Dr. Tim Sandle is Digital Journal's Editor-at-Large for science news. Tim specializes in science, technology, environmental, business, and health journalism. He is additionally a practising microbiologist; and an author. He is also interested in history, politics and current affairs.

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