The ACA Medicaid Expansion in Michigan and Financial Health

BACKGROUND: The state of Michigan created the Healthy Michigan Plan (HMP) to expand Medicaid eligibility to low-income adults under the Affordable Care Act (ACA) in April of 2014. We examined whether those who enrolled in the HMP had improved financial outcomes.

METHODS: We compared changes in amount of credit market debt past due, debt sent to a collection agency, and medical debt sent to a collection agency among HMP enrollees prior to the expansion (July 2011- January 2014) and after the expansion (July 2014- January 2016) relative to non-elderly adults in low-income zip codes in states that did not adopt the ACA Medicaid expansions. The sample consisted of 477,803 HMP enrollees and 830,181 non-elderly adults in non-expansion states. We also examined the effect of HMP among subgroups based on income level, use of medical services, and presence of a chronic disease during the first 12 months of enrollment.

RESULTS: Enrollment in HMP was associated with reductions in the amount of debt sent to a collection agency (-$301.98; P <0.001), the amount of medical debt sent to a collection agency (-$129.10; P <0.001), and the amount of credit market debt 30 days past due or more (-$115.25; P <0.001). Similar effects were estimated across all subgroups.

CONCLUSIONS

The ACA Medicaid expansion in Michigan was associated with improved financial well-being for enrollees.