When the Healthy Michigan Plan opened its doors to low-income adults just over a decade ago, it quietly launched one of the most ambitious health coverage experiments in the nation. Now, a sweeping University of Michigan report reveals what that expansion has delivered: 690,000 people covered, uninsurance rates that fell and stayed down, and hospitals no longer drowning in unpaid care.
The stakes of this moment are high. Thirty-nine other states have already expanded their own Medicaid programs, and across the country, policymakers are watching to see what works—especially as new federal rules begin taking effect in 2028, requiring cost-sharing through copays and work requirements that could reshape coverage nationwide. Michigan's decade-long story offers crucial lessons.
The numbers tell a compelling story of lives stabilized. Between 2014 and 2023, the Healthy Michigan Plan enrolled adults aged 19 to 64 with incomes up to 133 percent of the poverty level—roughly $21,600 annually for a single adult. More than 690,000 Michiganders are now enrolled in HMP managed care plans or fee-for-service coverage. When combined with traditional Medicaid and the MiChild program for younger residents, more than one in four Michiganders—2.5 million people—now have some form of Medicaid coverage.
But beyond enrollment numbers, the report, led by John Z. Ayanian, M.D., M.P.P., director of the U-M Institute for Healthcare Policy and Innovation, shows concrete changes in how people live. Uninsurance rates dropped significantly and remained low. Enrollees shifted away from expensive emergency care toward primary care clinics. Employment increased among people who had previously been unemployed, regardless of their health status. Personal financial stress eased: enrollees' debt in collections and credit scores improved on average. Hospitals saw their uncompensated care plummet—a relief for institutions that had been absorbing the cost of treating uninsured patients.
Perhaps most striking, during the same decade, hospitals in states that refused to expand Medicaid did not experience these same reductions in uninsurance or uncompensated care. The comparison is stark and deliberate.
The Healthy Michigan Plan included features that other states may adopt as new federal requirements kick in: copays and monthly premiums for enrollees, as well as financial incentives tied to healthy behaviors. The report finds these cost-sharing mechanisms produced mixed results—not uniformly positive, but worth understanding as other states navigate similar territory.
The expansion proved its mettle during crisis. When COVID-19 hit and workers lost jobs overnight, Medicaid expansion had already created infrastructure to absorb that shock. The coverage helped the state weather economic upheaval by keeping newly unemployed residents insured and connected to care.
Ayanian and his team have been tracking Michigan's expansion since its inception, releasing findings that have already shaped state policy and influenced how health plans serve enrollees. Their latest report includes recommendations, several of which the state government and private health plans have already implemented.
As federal Medicaid rules tighten and states prepare for new cost-sharing requirements, Michigan's evidence stands as a north star: Medicaid expansion works. It reduces uninsurance, it stabilizes lives, and it strengthens the hospitals and clinics that serve entire communities. The question now is whether other states will learn from a decade of proof.