Publications

Michigan’s expanded Medicaid program, the Healthy Michigan Plan (HMP), has provided health insurance coverage to hundreds of thousands of Michiganders since its launch in April 2014. However, in 2019, the state passed a work requirements bill, which introduced more steps needed to retain HMP coverage. The bill asked HMP enrollees to report a minimum of 80 hours of work per month to keep their insurance benefits. Consequently, to reduce the number of people who might lose coverage due to lack of reporting their hours, MDHHS developed a robust communication strategy. Their strategy used input from users, and applied a human-centered design. The Center for Health and Research Transformation (CHRT) at the University of Michigan evaluated this work. Results from the evaluation are published in this month’s JAMA Health Forum.

The CHRT team led 11 focus groups and fielded a survey to collect data from community health navigators, who help enrollees complete the paperwork needed to obtain and maintain coverage. Navigators reported that many of the steps taken by the state to improve the implementation of the bill for those on HMP insurance were helpful.  

While Medicaid communications are traditionally text heavy and technical, MDHHS used simplified language, streamlined the format, and employed attention-grabbing colors and icons in letters to beneficiaries. 

Findings

“MDHHS worked with external communication experts and this novel approach had a very positive impact,” said Patrick Kelly, lead author of the evaluation, who completed the survey while serving on CHRT’s research and evaluation team. “Respondents reported that traditional Medicaid form letters may get lost in the shuffle and be challenging for beneficiaries to understand…With the revamped letters, it appeared that beneficiaries’ attention was drawn to the envelopes. Many even brought the letters with them when meeting with navigators to discuss next steps.” 

While navigators reported overall improvements from traditional Medicaid communications, they were concerned that the policy itself was very complex to understand, and therefore to apply. This included some challenges regarding the communication around exemptions and concerns about internet, telephone, computer, and language barriers. 

Research shows that administrative burdens can lessen the utility of public health programs. The state of Michigan took steps to shift the administrative burden from individual beneficiaries by using administrative data where possible to automatically exempt and deem people in compliance with the policy. “This is a great improvement for the enrollees who are not always in a position to handle administrative requirements,” said Kelly.

In spite of these efforts, had Michigan continued to enforce the policy, it would have revoked health insurance coverage from about 80,000 enrollees.

Conclusions

Public agencies could apply this study’s results to other public benefit programs and policies. This would improve implementation and ensure that everyone can receive their authorized benefits.

“As the federal public health emergency will soon end and many individuals will need to re-apply to maintain Medicaid coverage, state Medicaid agencies can learn from Michigan’s experience by using enhanced human-centered design approaches to communicating with beneficiaries,” says Dr. Renu Tipirneni, a widely regarded expert on the impact of health reform policies and programs on low socioeconomic status, aging, and other vulnerable populations, and on delivery of care in the health care safety net.

Cited article:
Kelly RP, Marcu G, Hardin A, Iovan S, Tipirneni R. Health Navigator Perspectives on Implementation of Healthy Michigan Plan Work Requirements. JAMA Health Forum. 2022;3(6):e221502. doi:10.1001/jamahealthforum.2022.1502