Evaluation of the Healthy Michigan Plan Section 1115 Community Engagement Requirement Waiver

Health Insurance Clinical Trial

Official title:

Evaluation of the Healthy Michigan Plan Section 1115 Community Engagement Requirement Waiver

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT04207905
• Other study ID #: HUM00168117
• Status: Terminated
• Start date: January 1, 2020
• Est. completion date: March 4, 2020

Study information

• Verified date: March 2024
• Source: University of Michigan
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The Centers for Medicare & Medicaid Services (CMS) approved the renewal of the Healthy Michigan Plan (HMP) Section 1115 Demonstration Waiver on December 21, 2018, for the period January 1, 2019-December 31, 2023. This waiver provides approval for the state to require Medicaid expansion beneficiaries ages 19-62 to complete and report 80 hours per month of community engagement as a condition of eligibility, among other waiver provisions, beginning January 1, 2020. Community engagement activities include employment, education, job training, job search activities, participation in substance use disorder (SUD) treatment, or community service.

The State of Michigan will implement a randomized controlled trial (RCT) to evaluate the impact of community engagement requirements on Medicaid enrollment, health insurance coverage, self-reported health status, access to and utilization of health services, earnings, and employment, compared to a control group of HMP enrollees exempted from the community engagement requirement for purposes of the evaluation.

Description:

Goals of the Demonstration

As stated by the Michigan Department of Health and Human Services (MDHHS), the overarching goals of the Healthy Michigan Plan (HMP) demonstration are to increase access to quality health care, encourage the utilization of high-value services, promote beneficiary adoption of healthy behaviors, and implement evidence-based practice initiatives.

The main objectives of MDHHS for HMP include:

• Improving access to healthcare for uninsured or underinsured low-income Michigan residents;

• Improving the quality of healthcare services delivered;

• Reducing uncompensated care;

• Strengthening beneficiary engagement and personal responsibility;

• Encouraging individuals to seek preventive care, adopt healthy behaviors, and make responsible decisions about their healthcare;

• Supporting coordinated strategies to address social determinants of health in order to promote positive health outcomes, greater independence, and improved quality of life;

• Helping uninsured or underinsured individuals manage their health care issues;

• Encouraging quality, continuity, and appropriate medical care.

The evaluation for this demonstration is focused on examining:

• The impact of the community engagement requirement on enrollees' employment, earnings and financial well-being; enrollment in other public support programs; health outcomes; and health insurance status (HMP, commercial health insurance, or uninsurance);

• The extent to which new eligibility and coverage policies impact:

• Hospital uncompensated care

• Insurance coverage in the state

• Overall HMP enrollment and characteristics of HMP enrollees

• Enrollees' health care utilization

• Medicaid health service expenditures

• The impact HMP has had on enrollees' health outcomes, employment status, and financial well-being;

• The experiences of HMP enrollees who are disenrolled regarding insurance coverage status, access to care, and re-enrollment; and

• Medicaid program sustainability, including Medicaid expenditures.

The RCT design involves the random selection of a control group of HMP enrollees from across the state who are expected to be subject to the community engagement requirement but who are designated as being not subject to this requirement during the evaluation period (January 1, 2020 through December 31, 2023). This control group will be compared to an intervention group of HMP enrollees who will be subject to the community engagement requirement. Individuals who enroll in HMP after randomization occurs will not be eligible for inclusion in the control group.

The random selection of the control group (22,917 HMP enrollees, representing 10% of the individuals identified as subject to the work requirements as of November 2019) was performed in December 2019. This sample size for the control group will enable longitudinal analysis of key outcomes (e.g., employment, insurance coverage, self-reported health status, health services utilization, income, and credit outcomes) over the demonstration period, with sufficient statistical power to assess differences in these outcomes.

Data sources will include beneficiary surveys; state administrative data, including Medicaid enrollment files, Medicaid administrative claims, specialty behavioral health administrative claims, Michigan Care Improvement Registry immunization history, health risk assessment tables, cost-share tables, and other Medicaid tables; state workforce data, including state unemployment insurance program data; and public use data, including American Community Survey, Current Population Survey, Medicaid enrollment data from Medicaid Budget and Expenditure System (MBES), Medicaid and Medicare cost reports, Credit data, Behavioral Risk Factor Surveillance System, Healthcare Cost & Utilization Project (HCUP) inpatient discharge data, and program administrative cost data.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 892
• Est. completion date: March 4, 2020
• Est. primary completion date: March 4, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 19 Years to 62 Years

Eligibility

Inclusion Criteria: Enrollees eligible for the HMP community engagement requirement, including:

• Adult HMP beneficiaries ages 19-62 who are not otherwise exempt.

Exclusion Criteria: Enrollees exempt from the community engagement requirement includiung:

• Pregnant women

• Primary caregivers of a family member under six years of age (limited to one caregiver per household)

• Caretakers of a dependent with a disability who needs full-time care (allowed for one beneficiary per household if there is only one dependent with a disability who meets the criteria specified above in the household)

• Caretakers of an incapacitated individual even if the incapacitated individual is not a dependent of the caretaker

• Beneficiaries considered medically frail

• Beneficiaries currently receiving temporary or permanent long-term disability benefits from a private insurer or from the government

• Beneficiaries diagnosed with an acute medical condition that would prevent them from complying with the requirements

• Beneficiaries who have been incarcerated within the last six months

• Beneficiaries currently receiving unemployment benefits from the state

• Beneficiaries under 21 years of age who had previously been in foster care placement in Michigan

• Full-time students.

Related Conditions & MeSH terms

• Health Insurance

Intervention

Other:
• Healthy Michigan Plan (HMP) coverage with work requirements
For those who are not in the Exempt for Research Purposes group, to be eligible for HMP coverage beginning January 1, 2020, enrollees ages 19-62 must report 80 hours per calendar month of community engagement activities, such as employment, education, job training, job search activities, participation in substance use disorder (SUD) treatment, or community service.

Locations

Country	Name	City	State
United States	University of Michigan	Ann Arbor	Michigan

Sponsors (2)

Lead Sponsor	Collaborator
University of Michigan	Michigan Department of Health and Human Services

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Insurance coverage	Insurance coverage (self-reported uninsurance, employer-sponsored insurance, other types of insurance)	3 years
Primary	Enrollment in Medicaid	Enrollment in Medicaid (Medicaid eligibility data)	4 years
Primary	Employment	Employment status (self-reported)	3 years
Primary	Employment record	Employment status (state unemployment insurance data)	4 years
Primary	Educational enrollment	Educational enrollment (self-reported)	3 years
Primary	Job training participation	Job training participation (self-reported)	3 years
Primary	Number of hours worked	Number of hours worked (self-reported)	3 years
Primary	Number of hours worked, recorded	Number of hours worked (state unemployment insurance data)	4 years
Primary	Earnings	Income (state unemployment insurance data)	4 years
Primary	Income	Income (Medicaid eligibility data)	4 years
Primary	Health status, overall	Health status, overall (self-reported)	3 years
Primary	Days poor physical health	Days poor physical health (self-reported)	3 years
Primary	Days poor mental health	Days poor mental health (self-reported)	3 years
Primary	Days limited in usual activities due to health	Days limited in usual activities due to health (self-reported)	3 years
Secondary	Emergency room (ER) visits	Emergency room (ER) visits in past 12 months (Medicaid claims and encounter data)	4 years
Secondary	Hospital admissions in past 12 months	Hospital admissions in past 12 months (Medicaid claims and encounter data)	4 years
Secondary	Financial well-being	Financial well-being (self-reported)	3 years
Secondary	Material hardship	Material hardship (self-reported)	3 years
Secondary	Credit report outcomes	Credit scores, debt past due, medical bills in collections, public records including evictions, bankruptcies, wage garnishments	4 years
Secondary	Enrollment in TANF	Enrollment in Temporary Assistance for Needy Families (TANF enrollment data)	4 years
Secondary	Enrollment in SNAP	Enrollment in Supplemental Nutrition Assistance Program (SNAP enrollment data)	4 years

External Links

•   Healthy Michigan Plan evaluation webpage of the University of Michigan Institute for Healthcare Policy & Innovation