Journal of General Internal Medicine

, Volume 33, Issue 11, pp 1845–1847 | Cite as

Cost Conversations Between Primary Care Providers and Patients with Expanded Medicaid Coverage

  • Renuka TipirneniEmail author
  • Minal R. Patel
  • Matthias A. Kirch
  • Susan D. Goold
Concise Research Reports


Patients face increasing out-of-pocket (OOP) costs for healthcare,1 which have been associated with medication non-adherence and poor health outcomes.2, 3 While low-income patients may frequently have concerns about OOP costs—even if they have insurance with generous covered benefits—they may not raise cost concerns with physicians. Little is known about cost conversations between primary care providers (PCPs) and low-income patients. Our objective was to determine the frequency, predictors, and PCPs’ perceptions of the impact of cost conversations with low-income patients in an expanded Medicaid program in Michigan (“Healthy Michigan Plan” [HMP]), a state program for adults ages 19–64 with incomes ≤ 138% of the federal poverty level (FPL) and includes limited cost-sharing for beneficiaries (≤ 2% of income).


We conducted a mailed survey of all PCPs caring for ≥ 12 HMP patients in June–November 2015. The sample was derived from the Michigan Department of Health and...


out-of-pocket costs health insurance medicaid physician-patient communication 



We gratefully acknowledge the contribution of other evaluation team members who contributed to survey development and administration including Eric G. Campbell, PhD; John Z. Ayanian, MD MPP; Cengiz Salman, MA; Sarah J. Clark, MPH; Tammy Chang, MD MPH MS; Adrianne N. Haggins, MD MSc; Edith C. Kieffer, PhD; Lisa Szymecko, JD PhD; Sunghee Lee, PhD; Erica Solway, PhD MPH MSW; Erin Beathard, MPH MSW; and Zachary Rowe, BS.


The study was funded by a contract from the Michigan Department of Health and Human Services (MDHHS) to the University of Michigan to conduct an evaluation of the Healthy Michigan Plan, as required by the Centers for Medicare and Medicaid Services (CMS) through a Section 1115 Medicaid waiver.


The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of MDHHS or CMS.


Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Renuka Tipirneni
    • 1
    • 2
    Email author
  • Minal R. Patel
    • 1
    • 3
  • Matthias A. Kirch
    • 1
  • Susan D. Goold
    • 1
    • 2
    • 3
    • 4
  1. 1.Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborUSA
  2. 2.Division of General Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  3. 3.School of Public HealthUniversity of MichiganAnn ArborUSA
  4. 4.Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborUSA

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