Understanding Medicaid

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Today on Health Lab, we’re exploring Medicaid: What it is, what it does, and 10 things that U-M researchers have learned about Medicaid and its impact. Visit our website to read the full article.

Resources

More on Medicaid research from the University of Michigan Institute for Healthcare Policy & Innovation (IHPI):

• Research on Medicaid by U-M faculty who belong to IHPI
• IHPI’s evaluation of Michigan’s Medicaid expansion

Transcript

Host:

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

Today on Health Lab, we’re exploring Medicaid: What it is, what it does, and 10 things that U-M researchers have learned about Medicaid and its impact.

There is a lot of discussion about Medicaid in the news, but that discussion rarely focuses on what Medicaid does. 

So, what does it do?

No matter where you live in the United States, or where you get your health insurance, you probably know people who get their health care coverage through Medicaid. This is because the number of people on Medicaid nationwide is just under 80 million people.

To put it another way, one in five people in the United States rely on Medicaid for their health insurance.

Most Medicaid recipients are older adults, people with disabilities, children and pregnant people, but many others rely on it too, and crucially, this coverage specifically provides health insurance to people with low incomes.

Having Medicaid coverage makes healthcare accessible for many people for whom cost would be a prohibitive barrier otherwise. With Medicaid, Americans who need healthcare can get care from hospitals, doctor’s offices, clinics, nursing homes, pharmacies, home care services and mental health therapists for little or no cost.

Medicaid covers 4 out of every 10 births in the United States, half of all children, and more than half of long-term nursing home stays.

But all that care costs about $880 billion a year – a sizable chunk of federal and state budgets. 

That’s why policymakers in Washington, D.C., and state capitals are discussing the future of Medicaid and its program for children and teens, the Children’s Health Insurance Program, also known as CHIP.

To help them make decisions, policymakers can turn to studies done by Medicaid researchers at the University of Michigan Institute for Healthcare Policy and Innovation. 

As IHPI’s director and longtime Medicaid researcher Dr. John Ayanian notes, “Over the last 60 years, and especially the last decade, Medicaid has grown into a comprehensive program that not only provides critical health care services to those who need them but also helps support the broader health care system we all rely on, including hospitals, nursing homes and specialized facilities for children’s health. But with that growth has come growth in costs, and policymakers want to make sure they’re spending wisely. That’s where research comes in.” 

In service of that, today on Health Lab, we’re sharing 10 things that researchers at U-M have shown about Medicaid:

1. It leads to better health and less risk of dying: 
2. It supports the responsible use of health care: 
3. It enhances use of high-value care. The term “high value care” means care that studies have shown a person can really benefit from, because of their specific age, health conditions and other factors:
4. It helps people with low incomes stay in their jobs, seek jobs or train for jobs if they are able:
5. It helps people with mental health conditions access the care they need, including those with addiction to drugs or alcohol: 
6. It helps older adults who qualify for both Medicare and Medicaid:
7. Its telehealth coverage helps people get care they wouldn’t otherwise get:
8. It helps people improve their financial health:
9. It can help people get dental care that can affect their overall health and ability to work:
10. It helps keep hospitals and clinics financially stable and able to provide care for all: 

A review of all available studies by a pair of U-M researchers comes to this key conclusion, which is present for all types of insurance, but the effect is especially clear in studies of people enrolled in Medicaid. 

This review includes the work of another U-M researcher and her colleagues, who studied data from the first three years after states gained access to more federal dollars so they could expand Medicaid to cover more people. 

They found that deaths dropped by more than 9% among low-income people in expansion states compared with those in states that didn’t expand Medicaid. 

Following this trend, if all states had expanded the program, more than 15,000 deaths would have been prevented in just three years. 

Dr. Ayanian and his colleagues have studied the people who receive Medicaid coverage through the Healthy Michigan Plan, which in May 2025 includes more than 700,000 people across all counties of the state. 

Their recent report showed that nearly all surveyed enrollees have a primary care provider, that 81% of them saw that provider in the last year, and that long-term enrollees were very likely to get preventative cancer screenings like mammograms. 

Additionally, those who had regular preventive care were less likely to need emergency care.

A U-M study compared states that expanded Medicaid in the last decade with those that didn’t. 

The comparison showed a 19% increase in the likelihood that a clinic visit by a new Medicaid enrollee would include high-value care in expansion states. In non-expansion states, that same measure dropped by 24% during the same timeframe. 

U-M researchers found that half of the people in Michigan’s Medicaid expansion program already work full or part-time, even though their income is still low enough to qualify for the program. 

The remainder of recipients are either out of work, studying or training for a career, or unable to work due to health issues, caregiving obligations or other factors.

U-M researchers found that the percentage of people enrolled in Michigan's Medicaid expansion program who had jobs or were enrolled in school jumped six percentage points in one year, which was a bigger jump than the state’s overall employment.

Another U-M study showed that 69% of enrollees who had jobs said they were doing better at work since enrolling in Medicaid, and 55% of those who were out of work said the coverage made them better able to look for a job.

U-M research finds that about half of the people covered by Michigan’s Medicaid expansion program have what are called behavioral health conditions, including mental health disorders such as depression, or addiction to alcohol or drugs.

The team found that people with these conditions got an especially big boost in many health and work-related measures after enrolling in the program - an even bigger boost comparatively than the improvements seen in people who enrolled in the program who didn’t have a behavioral health condition.

A study by a U-M team also shows that when states “unwound” the special Medicaid enrollment that started during the pandemic, people who were taking medication that treats opioid addiction were more likely to have disruptions in their access to that medicine if they lived in one of the states that had the biggest drops in Medicaid enrollment.

When someone is over the age of 65 and has an especially low income, even with Social Security benefits and other sources, they can qualify for both Medicare and Medicaid. 

These “dual eligible” individuals often have a lot of medical needs, and research has shown the positive impact that Medicaid coverage has had for them.

A recent U-M study showed that dual-eligible individuals who lost their Medicaid coverage during the “unwinding” process and then re-enrolled were much more likely to say that they had missed getting care due to cost, especially dental care and home care.

Another U-M study showed that when a dual-eligible person’s income rose to just above Medicaid-eligible levels, they were then much less likely to see the doctor and less likely to be able to afford prescription medications. The data showed this was especially true in Black and Hispanic communities.

People with low incomes often face significant barriers to getting medical care in person, including transportation challenges and caregiving duties.

A recent U-M study asked people with Medicaid about their use of video and phone telehealth to get care. 

Nearly two-thirds of those who had a telehealth appointment in the past year said they received care that they could not or would not have received otherwise.

Because Medicaid plans are designed for people with low incomes, people with Medicaid coverage only have to pay a few dollars, if anything, for healthcare appointments or prescriptions. 

But Medicaid has an even greater impact on the financial health of those who enroll.

One U-M study showed that in just the first year after enrolling, Michigan Medicaid expansion participants had sizable drops in their unpaid debts — medical debts and overdrawn credit cards in particular — and fewer bankruptcies and evictions, while their credit scores and approvals for car loans rose. 

People with chronic illnesses or those who had a hospital stay or an emergency department visit after they enrolled saw the largest financial benefits.

While dental coverage under Medicaid varies from state to state, studies suggest it can have a major impact when it’s included.

Of people who saw a dentist within two years of getting coverage through Michigan’s Medicaid expansion program, 57% said their dental health had improved in that short time, and the majority of those with or without jobs said their improved oral health helped them do a better job at work or made them better able to look for a job.

Dr. Ayanian and his colleagues have surveyed health care providers about the impacts of the Medicaid expansion in the state, and looked at data on Michigan hospitals from public sources.

They found that Michigan hospitals saw the amount of care for which they did not receive payment (also called uncompensated care) drop by half after Medicaid expansion, and that the percentage of hospitalized patients without insurance dropped by 69%. 

Primary care providers and safety-net clinics also reported improvements in financial stability and their ability to add services. 

Links to learn more about the research on Medicaid by U-M faculty who belong to IHPI, and more about IHPI’s evaluation of Michigan’s Medicaid expansion will be linked in the show notes for this episode.

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