Medicaid Coverage Associated With Employment Gains

Individuals in Michigan with low incomes and health problems were more likely to have employment gains when they were covered with Medicaid, which could have implications when work requirements change for Medicaid in 2027, a new study published in JAMA Health Forum¹ found.

Medicaid coverage has been expanded in 40 states and Washington, D.C., which allows adults with incomes that are 138% of the Federal Poverty Level to sign up for Medicaid coverage.² States that have expanded Medicaid also receive an enhanced federal matching rate for the individuals who have signed up for Medicaid under that expansion. However, in 2027, all expansion states will be forced to enforce new work requirements for their populations to obtain Medicaid, which could leave those who fill out their forms wrong or who are unaware of the requirements without Medicaid. This study aimed to identify the connection between employment outcomes and health burden levels in Michigan, a state with Medicaid expansion.

The researchers conducted a telephone survey from January 1 to October 31, 2016, conducted in Arabic, English, and Spanish. There were 2 follow-up surveys conducted from March 2017 to January 2018 and between June 2018 and January 2019. Each survey assessed employment status, demographic characteristics, and self-reported health burden. Pearson χ² tests were used to assess the association between health burden and employment.

There were 2608 respondents who were included due to their response to all follow-up surveys. The mean (SD) age of this cohort was 40.4 (12.8) years, and 51.5% were women. Chronic conditions were found in 57.2% (95% CI, 54.8%-59.6%) of the respondents. A total of 48.2% (95% CI, 45.9%-50.4%) of the respondents were employed, of which 67.4% were full-time as of 2018. A total of 54.6% of those who gained employment after the first survey were employed full-time.

From 2016 to 2018, employment gains increased from 18.9% to 32.2% in those with substantial health burdens, 43.1% to 54.1% in those with moderate health burdens, and 57.9% to 67.5% in those with minimal health burdens. The largest employment gains were found in those whose health improved from substantial or moderate health burdens.

Improved health was associated with working full time in those with substantial or moderate health burdens in 2016 who gained employment, whereas no improvement was found in those who worked part time. A total of 20.7% of unemployed beneficiaries in 2016 with improved health burden found full-time work, and 16.5% found part-time work by 2018. A total of 38.3% of beneficiaries who were unemployed in 2016 whose health improved were employed in 2018. This was compared with 13.5% of unemployed beneficiaries in 2016 who had unchanged or worse health by 2018.

Individuals were more likely to be employed if they were unemployed beneficiaries with improved health burden (adjusted OR, 4.13; 95% CI, 2.33-7.31) compared with those who had the same or worsened health burden. Full-time employment gains were associated with health burden improvements (adjusted OR, 6.12; 95% CI, 2.66-14.05).

“These findings show that Medicaid expansion doesn't discourage work—it helps make it possible. By improving health, Medicaid allows people to participate more fully in the workforce," lead author Minal Patel, PhD, said in a statement.³

There were some limitations to this study. Participants were not asked if they were seeking work or had other barriers to employment as part of the survey. All data were self-reported and from a single state.

“As states implement [the One Big Beautiful Bill Act Medicaid] requirements, they should minimize administrative burden while providing exemptions for people with substantial or moderate health burdens,” the authors concluded.

References

1. Patel MR, Clark SJ, Beathard E, et al. Employment and health burden changes among Medicaid expansion enrollment. JAMA Health Forum. 2025;6(10):e254639. doi:10.1001/jamahealthforum.2025.4639

2. Status of state Medicaid expansion decisions. KFF. September 29, 2025. Accessed October 29, 2025. https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/

3. As Medicaid work requirements loom, U-M study finds links between coverage, better health and higher employment. News release. Michigan Medicine – University of Michigan. October 31, 2025. Accessed October 31, 2025.