Journal of General Internal Medicine

, Volume 34, Issue 2, pp 272–280 | Cite as

Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study

  • Renuka TipirneniEmail author
  • Jeffrey T. Kullgren
  • John Z. Ayanian
  • Edith C. Kieffer
  • Ann-Marie Rosland
  • Tammy Chang
  • Adrianne N. Haggins
  • Sarah J. Clark
  • Sunghee Lee
  • Erica Solway
  • Matthias A. Kirch
  • Christina Mrukowicz
  • Erin Beathard
  • Erin Sears
  • Susan D. Goold
Original Research



Michigan expanded Medicaid under the Affordable Care Act (Healthy Michigan Plan [HMP]) to improve the health of low-income residents and the state’s economy.


To understand HMP’s impact on enrollees’ health, ability to work, and ability to seek employment


Mixed methods study, including 67 qualitative interviews and 4090 computer-assisted telephone surveys (response rate 53.7%)


Non-elderly adult HMP enrollees

Main Measures

Changes in health status, ability to work, and ability to seek employment

Key Results

Half (47.8%) of respondents reported better physical health, 38.2% better mental health, and 39.5% better dental health since HMP enrollment. Among employed respondents, 69.4% reported HMP helped them do a better job at work. Among out-of-work respondents, 54.5% agreed HMP made them better able to look for a job. Among respondents who changed jobs, 36.9% agreed HMP helped them get a better job. In adjusted analyses, improved health was associated with the ability to do a better job at work (aOR 4.08, 95% CI 3.11–5.35, p < 0.001), seek a job (aOR 2.82, 95% CI 1.93–4.10, p < 0.001), and get a better job (aOR 3.20, 95% CI 1.69–6.09, p < 0.001), but not with employment status (aOR 1.08, 95% CI 0.89–1.30, p = 0.44). In interviews, several HMP enrollees attributed their ability to get or maintain employment to improved physical, mental, and dental health because of services covered by HMP. Remaining barriers to work cited by enrollees included older age, disability, illness, and caregiving responsibilities.


Many low-income HMP enrollees reported improved health, ability to work, and job seeking after obtaining health insurance through Medicaid expansion.



We thank the following evaluation team members for their additional contributions to survey and interview development and administration: Lisa Szymecko, JD, PhD; Cengiz Salman, MA; Tolu Olorode, MSW, MUP; Zachary Rowe, BBA; and the members of the Community Advisory Board (Adnan Hammad, Global Health Research, Management and Solutions; Lynnette LaHahnn, AuSable Valley Community Mental Health Authority; Charo Ledón, Acción Buenos Vecinos; Raymond Neff, Spectrum Health; Jennifer Raymond, Mid Michigan Community Action; George Sedlacek, Marquette County YMCA; and Ashley Tuomi, American Indian Health and Family Services). We also thank Sarah Sugar, BA, for assistance with literature review, and Helen Levy, PhD, for thoughtful comments on earlier drafts of this manuscript.

Funding Source

The study was funded by a contract from the Michigan Department of Health and Human Services (MDHHS) to the University of Michigan to conduct an evaluation of the Healthy Michigan Plan, as required by the Centers for Medicare and Medicaid Services (CMS) through a Section 1115 Medicaid waiver.

Prior Presentations

Preliminary findings were presented at the Society of General Internal Medicine Annual Meeting, Washington, DC, April 2017, and at the AcademyHealth Annual Research Meeting, New Orleans, LA, June 2017.


The Michigan Department of Health and Human Services (MDHHS) funded the study and approved the manuscript, but had no role in the conduct of the research, data analysis, interpretation of findings, or drafting of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of MDHHS.

Dr. Tipirneni is additionally supported by a K08 Clinical Scientist Development Award from the National Institute on Aging. Support was also provided to Dr. Kullgren by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. Dr. Kullgren is a VA HSR&D Career Development awardee at the Ann Arbor VA. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Compliance with Ethical Standards

Conflict of Interest

Dr. Kullgren has received consulting fees from SeeChange Health and HealthMine, and a speaking honorarium from AbilTo, Inc. There are no other conflicts of interest.

Supplementary material

11606_2018_4736_MOESM1_ESM.pdf (519 kb)
ESM 1 (PDF 518 kb)


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Renuka Tipirneni
    • 1
    • 2
    Email author
  • Jeffrey T. Kullgren
    • 1
    • 2
    • 3
    • 4
  • John Z. Ayanian
    • 1
    • 2
    • 5
    • 6
  • Edith C. Kieffer
    • 1
    • 7
  • Ann-Marie Rosland
    • 8
    • 9
  • Tammy Chang
    • 1
    • 10
  • Adrianne N. Haggins
    • 1
    • 11
  • Sarah J. Clark
    • 1
    • 12
  • Sunghee Lee
    • 1
    • 13
  • Erica Solway
    • 1
  • Matthias A. Kirch
    • 1
  • Christina Mrukowicz
    • 1
  • Erin Beathard
    • 1
  • Erin Sears
    • 1
    • 3
  • Susan D. Goold
    • 1
    • 2
    • 3
    • 5
  1. 1.Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborUSA
  2. 2.Division of General Medicine, Department of Internal Medicine University of MichiganAnn ArborUSA
  3. 3.Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborUSA
  4. 4.VA Ann Arbor Center for Clinical Management ResearchUniversity of MichiganAnn ArborUSA
  5. 5.School of Public HealthUniversity of MichiganAnn ArborUSA
  6. 6.Gerald R. Ford School of Public PolicyUniversity of MichiganAnn ArborUSA
  7. 7.School of Social WorkUniversity of MichiganAnn ArborUSA
  8. 8.Department of Internal MedicineUniversity of PittsburghPittsburghUSA
  9. 9.VA Pittsburgh Center for Health Equity Research and PromotionPittsburghUSA
  10. 10.Department of Family MedicineUniversity of MichiganAnn ArborUSA
  11. 11.Department of Emergency MedicineUniversity of MichiganAnn ArborUSA
  12. 12.Department of PediatricsUniversity of MichiganAnn ArborUSA
  13. 13.Institute for Social ResearchUniversity of MichiganAnn ArborUSA

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