Redetermination and Enrollment: Evidence at Work (RENEW)

Last registered on June 25, 2024
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Pre-Trial

Trial Information

General Information

Title
Redetermination and Enrollment: Evidence at Work (RENEW)
RCT ID
AEARCTR-0013501
Initial registration date
June 24, 2024

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
June 25, 2024, 2:13 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name
Adrianna McIntyre
Affiliation
Harvard University
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Timothy Layton
PI Affiliation
Harvard Medical School
PI Name
Kevin Callison
PI Affiliation
Tulane University School of Public Health & Tropical Medicine
PI Name
Jacob Wallace
PI Affiliation
Yale School of Public Health
PI Name
Stephen Barnes
PI Affiliation
University of Louisiana Lafayette

Additional Trial Information

Status
In development
Start date
2024-08-01
End date
2025-08-01
Keywords
Health
Additional Keywords
Medicaid, health insurance
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Take-up of safety net programs in the United States is often incomplete, ranging from 84% for SNAP and Medicaid adults to 25% for TANF. Administrative hassles involved with proving initial and continued eligibility, which often require substantial effort by enrollees, may contribute to the large number of eligible but unenrolled individuals and families. The expiration of the nationwide public health emergency related to COVID-19 will trigger eligibility redeterminations for tens of millions of American households and will require many of these households to go through a burdensome and confusing eligibility redetermination process. We propose to study the effect of these administrative hassles in the Medicaid program, where it is estimated that 89 million beneficiaries will be going through the eligibility redetermination process in 2023.

Our study has two goals: (1) assess the role of inaccurate beneficiary contact information and administrative frictions in impeding eligibility redetermination and (2) assess the effects of continued Medicaid enrollment on beneficiary health, labor supply, and well-being. We propose a set of scalable interventions, ranging from low- to medium-cost, that are designed to improve the targeting of Medicaid renewal forms, strengthen outreach, and make it easier to complete redetermination applications.

In partnership with a community partner conducting outreach to individuals up for Medicaid renewal, we will randomize (1) whether individuals' contact information is updated through a third-party vendor, (2) whether an individual is likely to be contacted by the community partner to be notified of their need to complete the renewal process (if scarce resources mean that the community partner cannot outreach all individuals on their contact list) and (3) whether an individual receives application assistance
External Link(s)

Registration Citation

Citation
Barnes, Stephen et al. 2024. "Redetermination and Enrollment: Evidence at Work (RENEW) ." AEA RCT Registry. June 25. https://doi.org/10.1257/rct.13501-1.0
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2024-08-01
Intervention End Date
2025-08-01

Primary Outcomes

Primary Outcomes (end points)
Renewal of Medicaid benefits without disenrollment during the redetermination period
Primary Outcomes (explanation)
We are testing outreach strategies intended to keep people continuously covered in Medicaid when renewal paperwork is required.

Secondary Outcomes

Secondary Outcomes (end points)
-Medicaid coverage at three, six, and twelve months after the renewal date to account for short term disruptions in coverage and unsuccessful renewals that are later overturned through the appeals process.
-Number of Medicaid paid office visits in the past 12 months
-Number of Medicaid prescription fills in the past 12 months
-Number of Medicaid paid ED visits in the past 12 months
-Number of Medicaid paid hospitalizations in the past 12 months
-Measures of care continuity for Medicaid members with chronic conditions, mental health issues, and substance use disorders
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Medicaid enrollees will be randomized in the following ways, on a rolling basis based on their Medicaid redetermination date.

Our community partner is conducting outreach to individuals who are up for Medicaid renewal and need to complete paperwork in order for the renewal to be successful. The Louisiana Department of Health (LDH) is providing our community partner with the names and contact information of people up for renewal on a rolling basis. As part of this study, the contact list will have individuals randomized (at the household level), such that people at the "top" of the list are more likely to be outreached (if the community partner is not able to work to the bottom of the list) or more likely to be outreached more than once (if the community partner does successfully work to the bottom of the list). These calls are intended to provide information to people about their need to complete the renewal process.

Second, a subset of individuals will be randomized to receive outbound calls from our community partner offering real-time application assistance. Our community partner has a certified application center that permits them to submit renewal applications on behalf of enrollees. Individuals will be advised that they may call back if they are not prepared to participate in the application assistance at the time of the phone call.

Third, independent of the randomization above, enrollees will be randomized to receive updated contact information (if available) through a third-party vendor.
Experimental Design Details
Not available
Randomization Method
Randomization done in office using statistical software (random number generator)
Randomization Unit
Randomization occurs at the household level (in cases where more than one Medicaid enrollee is associated with an address) because households may contain multiple Medicaid enrollees up for renewal at the same time. Medicaid requires the identity of a "head of household" for whom the contact information is available.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
N/A
Sample size: planned number of observations
60,000 individual enrollees
Sample size (or number of clusters) by treatment arms
All study enrollees will be included in the randomization of order of outreach
We anticipate approximately 5,000 people will be randomized to receive outbound application assistance
We anticipate approximately half (30,000) enrollees will be cross-randomized to the enhanced contact information arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

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