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Michigan's Approach to Medicaid Expansion and Reform

November 2013

John Z. Ayanian


Michigan is one of few Republican-controlled states to expand their Medicaid under new provisions of the Affordable Care Act. This article outlines the conditions that allowed Michigan to expand Medicaid while most similarly-situated governments declined to do so. These conditions are: 1. Michigan must make cuts to offset any costs of the program. 2. They will create incentives for Medicaid recipients to remain healthy. 3. Enrollees will be covered by private plans, not traditional Medicaid. 4. Enrollees will have access to primary and preventative care, and will clarify preferences for end-of-life care. 5. Michigan will make Medicaid data public and constantly monitor effects on premium prices and health outcomes.

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Policy Implications

The path taken by Michigan paves the way for other states to similarly address the concerns of Republican leaders and take part in Medicaid expansion that has been primarily limited to Democratic states.

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