• Susan Dorr Goold, Renuka Tipirneni, Tammy Chang, Matthias A Kirch, Corey Bryant, Zachary Rowe, Erin Beathard, Erica Solway, Sunghee Lee, Sarah J Clark, Jennifer Skillicorn, John Z Ayanian, and Jeffrey T Kullgren.
• Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. sgoold@umich.edu.
• J Gen Intern Med. 2020 Mar 1; 35 (3): 800-807.

BackgroundMedicaid expansion in Michigan, known as the Healthy Michigan Plan (HMP), emphasizes primary care and preventive services.ObjectiveEvaluate the impact of enrollment in HMP on access to and receipt of care, particularly primary care and preventive services.DesignTelephone survey conducted during January-November 2016 with stratified random sampling by income and geographic region (response rate = 53.7%). Logistic regression analyses accounted for sampling and nonresponse adjustment.Participants4090 HMP enrollees aged 19-64 with ≥ 12 months of HMP coverage MAIN MEASURES: Surveys assessed demographic factors, health, access to and use of health care before and after HMP enrollment, health behaviors, receipt of counseling for health risks, and knowledge of preventive services' copayments. Utilization of preventive services was assessed using Medicaid claims.Key ResultsIn the 12 months prior to HMP enrollment, 33.0% of enrollees reported not getting health care they needed. Three quarters (73.8%) of enrollees reported having a regular source of care (RSOC) before enrollment; 65.1% of those reported a doctor's office/clinic, while 16.2% reported the emergency room. After HMP enrollment, 92.2% of enrollees reported having a RSOC; 91.7% had a doctor's office/clinic and 1.7% the emergency room. One fifth (20.6%) of enrollees reported that, before HMP enrollment, it had been over 5 years since their last primary care visit. Enrollees who reported a visit with their primary care provider after HMP enrollment (79.3%) were significantly more likely than those who did not report a visit to receive counseling about health behaviors, improved access to cancer screening, new diagnoses of chronic conditions, and nearly all preventive services. Enrollee knowledge that some services have no copayments was also associated with greater utilization of most preventive services.ConclusionsAfter enrolling in Michigan's Medicaid expansion program, beneficiaries reported less forgone care and improved access to primary care and preventive services.

3 keywords...

hide…