New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.
Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.
That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.
These findings are from a recent study by Manatt Health, a national consulting firm and division of the legal and consulting firm of Manatt, Phelps and Phillips.
"If the state really does a lot to help facilitate reporting, to provide work supports that help people find jobs if they need them to be able to comply," said April Grady, director of Manatt Health and the study's lead author. "We could see disenrollment at the lower end."
Listen to Stateside's conversation with April Grady above.
The study's estimates are based on experience with Arkansas' work requirements with adjustments that reflect differences in Michigan. When the work requirement law was passed last year, the Senate Fiscal Agency analysis of the legislation did not include estimated enrollment impacts and the House Fiscal Agency noted that its estimated enrollment reductions were projected without actual experience from other states because there was no such data at the time.
Under Michigan's legislation, Healthy Michigan enrollees will be required to work an average of 80 hours per month or to enage in other qualifying activities such as education, job training, or drug-treatment, unless they get an exemption.
Grady said there will be serious ripple effects from the estimated large numbers of people becoming uninsured.
"People will delay health care. There have been reports of people stretching their prescriptions, not seeking care when they need it," Grady said. "So people end up sicker."
Grady said uninsured patients also place economic burdens on hospitals which are legally obligated to provide treatment.
"The estimates from this new report are rather shocking and should give legislators some pause as we move forward in this policy," said Emily Schwarzkopf, senior policy analyst for the Michigan League for Public Policy
"If the legislature continues down this path," Schwarzkopf said. "We need to make sure that those in Healthy Michigan know this is coming and we need to do everything we can to educate them on these requirements so that we can minimize the harm that may be caused."
Schwarzkopf said the Michigan Department of Health and Human Services will have a crucial role in educating Healthy Michigan recipients about the work requirement reporting process and making it accessible and simple to use. Schwarzkopf said it is important for health care providers and community groups to join in the education effort.