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

NCT04207905 | Terminated

• 1 other identifier: HUM00168117
• Study Type: observational
• Target: 892
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Health Insurance

Keywords

Medicaid Expansion; Work Requirement; Community Engagement Requirement

Outcome Measures

Primary Outcomes (14)

• Insurance coverage

  Insurance coverage (self-reported uninsurance, employer-sponsored insurance, other types of insurance)

  3 years

• Enrollment in Medicaid

  Enrollment in Medicaid (Medicaid eligibility data)

  4 years

• Employment

  Employment status (self-reported)

  3 years

• Employment record

  Employment status (state unemployment insurance data)

  4 years

• Educational enrollment

  Educational enrollment (self-reported)

  3 years

• Job training participation

  Job training participation (self-reported)

  3 years

• Number of hours worked

  Number of hours worked (self-reported)

  3 years

• Number of hours worked, recorded

  Number of hours worked (state unemployment insurance data)

  4 years

• Earnings

  Income (state unemployment insurance data)

  4 years

• Income

  Income (Medicaid eligibility data)

  4 years

• Health status, overall

  Health status, overall (self-reported)

  3 years

• Days poor physical health

  Days poor physical health (self-reported)

  3 years

• Days poor mental health

  Days poor mental health (self-reported)

  3 years

• Days limited in usual activities due to health

  Days limited in usual activities due to health (self-reported)

  3 years

Secondary Outcomes (7)

• Emergency room (ER) visits

  4 years

• Hospital admissions in past 12 months

  4 years

• Financial well-being

  3 years

• Material hardship

  3 years

• Credit report outcomes

  4 years

Study Arms (2)

Exempt for Evaluation Purposes

Individuals who would have been subject to the Healthy Michigan Plan (HMP) work requirements but have been randomly assigned to a control group that is exempt from reporting for evaluation purposes

Work Requirement

Individuals who are subject to the Healthy Michigan Plan (HMP) work requirements

Other: Healthy Michigan Plan (HMP) coverage with work requirements

Interventions

Healthy Michigan Plan (HMP) coverage with work requirements OTHER

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.

Work Requirement

Eligibility Criteria

• Age: 19 Years - 62 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)
• Sampling Method: Probability Sample

Study Population

Healthy Michigan Plan enrollees subject to the community engagement requirement are eligible for the study. The RCT design involves the random selection by the State of Michigan or its designee 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.

You may qualify if:

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

You may not qualify if:

• 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.

Sponsors & Collaborators

• University of Michigan: lead
• Michigan Department of Health and Human Services: collaborator

Study Sites (1)

University of Michigan

Ann Arbor, Michigan, 48109, United States

Location

Related Links

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

Study Officials

• John Z Ayanian, MD, MPP

  University of Michigan

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Director, Institute for Healthcare Policy and Innovation

Study Record Dates

• First Submitted: December 19, 2019
• First Posted: December 23, 2019
• Study Start: January 1, 2020
• Primary Completion: March 4, 2020
• Study Completion: March 4, 2020
• Last Updated: March 8, 2024

Record last verified: 2024-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)