New Findings on a Decade of Medicaid Expansion in Michigan

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A new U-M report shows that individuals, hospitals and primary care clinics all experienced positive impacts in the first decade of Michigan's Medicaid expansion, but the report also raises concerns about the cost-sharing provisions that all states must soon enact.

Read the full article on Health Lab.

Transcript 

Host: 

Welcome to Health Lab, your destination for news and stories about the future of healthcare.

Today we’re talking about Michigan’s Medicaid expansion.

A newly released report from the University of Michigan shows that individuals, hospitals and primary care clinics all experienced positive impacts, but the report also raises concerns about cost-sharing provisions that all states must soon enact.

Just over a decade ago, Michigan expanded its Medicaid health coverage program, opening it to all adults with very low incomes through the Healthy Michigan Plan.

Now, a new report shows the long term benefits of this expansion – not just for individuals but for primary care clinics and hospitals that serve all Michiganders.

The report also finds that some of the unique features of Michigan’s Medicaid expansion showed mixed results, such as cost-sharing in the form of copays and monthly premiums, and financial incentives for healthy behaviors.

The findings could inform the 39 other states that have expanded Medicaid, as they implement federal changes to Medicaid policy; changes that include work requirements for enrollees, as well as copays for some enrollees.

After analyzing a large amount of data from multiple sources, the U-M report shows a positive impact of the first 10 years of Michigan’s Medicaid expansion - from 2014 to 2023 - including: 

A large and sustained drop in the percentage of Michiganders with no health insurance. 

An increased use of primary care services. 

Reduced use of emergency care by enrollees. 

The improved health of many of those who enrolled, including significant improvements for some who reported sizable health challenges when they first gained coverage. 

Medicaid expansion in Michigan also increased employment among people who had previously been unemployed, regardless of health status, over the time period. 

Additionally, the report found less financial stress for both individuals and hospitals in Michigan as a result of expanding Medicaid, and included decreases in personal debt in collections and low credit scores for enrollees on average, as well as a substantial reduction in hospitals’ uncompensated care. 

During the same period of time, the report shows that hospitals in states that did not expand coverage also did not experience similar reductions in uninsurance or uncompensated care.

Previous reports by the same U-M team have shown that the Healthy Michigan Plan improved other aspects of enrollees’ lives as well, including the ability to work or seek work.

The new report also concludes that Medicaid expansion has increased the efficiency of other Michigan-wide health programs, and helped the state weather the economic upheaval of the COVID-19 pandemic by covering those who lost jobs and income.

John Z. Ayanian, M.D., M.P.P., who led the team that compiled the report says, “We hope our team’s robust evaluation can help all states understand the impacts of Medicaid expansion, including some of the cost-sharing features required under our state’s expansion legislation. Our findings are especially timely as states prepare to meet the requirements of new federal Medicaid cost-sharing provisions.”

Ayanian directs the U-M Institute for Healthcare Policy and Innovation, and leads the team of IHPI members and staff who have evaluated Michigan’s Medicaid expansion since shortly after it began.

The evaluation was funded by the Michigan Department of Health and Human Services, and was required under the state’s waiver from the federal Centers for Medicare and Medicaid Services.

The report includes multiple recommendations, some of which have already been implemented by the state government and the private health plans that partner with it to serve HMP enrollees.

The Healthy Michigan Plan is open to adults ages 19 to 64 who have incomes up to 133% of the poverty level, which currently sits at about $21,600 for a single adult. As of February 2026, more than 690,000 Michiganders were enrolled in HMP managed care plans or fee-for-service coverage.

In all, more than 1 in 4 residents of the state have some form of Medicaid coverage, including HMP, traditional Medicaid and the MIChild program for those up to age 19.

MiChild is Michigan’s program under the federal Children’s Health Insurance Program.

The report concluded, “Medicaid expansion has become a key component of the state’s healthcare system and safety net over the past decade and the Healthy Michigan Plan is likely to continue to play a vital role in promoting and supporting health and well-being in Michigan into the future.”

More findings from the report are included in the full article on Health Lab. The link for the article will be posted in the episode description.

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