Susan Dorr Goold1,2,3,4, Renuka Tipirneni5,6, Tammy Chang6,7, Matthias A Kirch6, Corey Bryant5,6, Zachary Rowe8, Erin Beathard6, Erica Solway6, Sunghee Lee9, Sarah J Clark6,10, Jennifer Skillicorn6,11, John Z Ayanian5,12,6,13, Jeffrey T Kullgren5,6,14. 1. Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. sgoold@umich.edu. 2. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA. sgoold@umich.edu. 3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. sgoold@umich.edu. 4. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA. sgoold@umich.edu. 5. Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 6. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. 7. Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 8. Friends of Parkside, Detroit, MI, USA. 9. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA. 10. Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA. 11. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA. 12. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA. 13. Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA. 14. VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Medicaid expansion in Michigan, known as the Healthy Michigan Plan (HMP), emphasizes primary care and preventive services. OBJECTIVE: Evaluate the impact of enrollment in HMP on access to and receipt of care, particularly primary care and preventive services. DESIGN: Telephone 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. PARTICIPANTS: 4090 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 RESULTS: In 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. CONCLUSIONS: After enrolling in Michigan's Medicaid expansion program, beneficiaries reported less forgone care and improved access to primary care and preventive services.
BACKGROUND: Medicaid expansion in Michigan, known as the Healthy Michigan Plan (HMP), emphasizes primary care and preventive services. OBJECTIVE: Evaluate the impact of enrollment in HMP on access to and receipt of care, particularly primary care and preventive services. DESIGN: Telephone 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. PARTICIPANTS: 4090 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 RESULTS: In 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. CONCLUSIONS: After enrolling in Michigan's Medicaid expansion program, beneficiaries reported less forgone care and improved access to primary care and preventive services.
Entities:
Keywords:
Medicaid; preventive care; primary care; regular source of care
Authors: Carmen Sayon-Orea; Silvia Carlos; Anaïs Rico-Campà; Alejandro Fernández-Montero; Carmen de la Fuente-Arrillaga; Estefanía Toledo; Stefanos Kales; Miguel Angel Martínez-González Journal: BMJ Open Date: 2022-01-12 Impact factor: 2.692