Enrollment Barriers, Procedural Denials, and Loss of Medicaid Coverage: A Randomized Trial to Identify Effective Outreach Solutions

Last registered on May 21, 2024


Trial Information

General Information

Enrollment Barriers, Procedural Denials, and Loss of Medicaid Coverage: A Randomized Trial to Identify Effective Outreach Solutions
Initial registration date
May 14, 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
May 21, 2024, 10:46 AM EDT

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

Last updated
May 21, 2024, 10:56 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.


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Primary Investigator

University of Wisconsin-Madison

Other Primary Investigator(s)

PI Affiliation
Texas A&M
PI Affiliation
Covering Wisconsin

Additional Trial Information

In development
Start date
End date
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Each year, millions of Medicaid beneficiaries must redemonstrate their eligibility to avoid losing coverage. Challenges with the required paperwork can result in eligible people losing their benefits for procedural reasons (i.e., because their paperwork was missing or contained errors). In 2023 alone, 9 million people lost Medicaid coverage for procedural reasons. This study will evaluate an intervention aimed at averting and remediating loss of Medicaid coverage for procedural reasons among eligible individuals. The experimental population includes 425,000 households in Wisconsin who lost Medicaid coverage for procedural reasons. The implementation partner is Covering Wisconsin, Wisconsin’s federally certified Navigator organization. Experimental arms include a group receiving a pre-recorded outbound call, a group receiving a live outbound call from a Navigator, and a no-outreach control group. We hypothesize that outreach from a Navigator will increase Medicaid re-enrollment, and although a pre-recorded call will be the most cost-effective option, a live call will be more effective among underserved or harder-to-reach populations. The goal of this research is to identify novel outreach methods to help low-income people maintain access to benefits, and thereby facilitate the advancement of equity in access to the safety net.
External Link(s)

Registration Citation

Dague, Laura, Allison Espeseth and Rebecca Myerson. 2024. "Enrollment Barriers, Procedural Denials, and Loss of Medicaid Coverage: A Randomized Trial to Identify Effective Outreach Solutions." AEA RCT Registry. May 21. https://doi.org/10.1257/rct.13617-1.2
Sponsors & Partners


Experimental Details


This study will test new outreach methods to improve access to health insurance coverage among people who lost Medicaid for procedural reasons. Specifically, we propose to evaluate the impacts of outreach from Navigators on gaps in Medicaid coverage among people disenrolled from Medicaid for procedural reasons. The implementation partner is Covering Wisconsin, Wisconsin’s Navigator program, which has a staff of professional enrollment assisters who inform and advise consumers on their Medicaid eligibility as well as enrollment and renewal processes on a one-on-one basis. The experimental arms will provide two forms of outreach (a pre-recorded outbound call providing a hotline number vs. a live outbound call from a Navigator). The control arm includes those not exposed to outreach—an available group given the capacity limits of Navigators.

The interventions address potential barriers to successful renewal, including lack of awareness of eligibility for Medicaid or the need for renewal or enrollment paperwork, and uncertainty about how to respond to information requests related to income or asset verification. Navigators will conduct initial outreach in English, Spanish, or Hmong according to the preference indicated in the DHS data. Details are as follows:

Live outbound call arm: Households in this arm will receive a call from a Navigator who can provide personalized assistance with health insurance enrollment. If this call results in a phone conversation, the Navigator will explain the status of the consumer’s renewal application and answer questions about eligibility and the paperwork required to renew or re-enroll in Medicaid coverage or other available coverage. If the consumer does not answer, the Navigator will leave a message with a hotline number.

Pre-recorded call arm: Households in this arm will receive an outbound call message with information about the availability of Navigators to help with the Medicaid enrollment process and answer related questions. Message wording will be informed by the research team’s understanding of the most common administrative barriers and the reasons these barriers are especially challenging.

Both types of calls will be conducted in the 90 days following the member’s renewal deadline. Within this period members can attempt renewal and, if successful, Medicaid will provide up to 3 months’ retroactive payment for any covered services provided during the gap in coverage.
Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
Reinstating Medicaid coverage within 3 months of their renewal deadline.
Primary Outcomes (explanation)
Under Wisconsin’s renewal policy mentioned above, those who renew in this timeframe can maintain continuous Medicaid coverage ex post, even after losing coverage for procedural reasons.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary outcomes include Medicaid coverage during the 6 months after the renewal deadline (measured each month), and the duration of any coverage gaps up to 6 months after the renewal deadline.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The experimental population will include people in Wisconsin who lost Medicaid coverage for procedural reasons at any time between June 2024 and November 2025. Exclusion criteria include preferring a language other than English, Spanish, or Hmong, and lacking a working phone number.

Assignment to treatment arms will occur monthly from July 2024 to December 2025. Randomization will be clustered by household. Households will be assigned to treatment arms in equal numbers, stratified by key characteristics that can affect eligibility and enrollment processes.
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer
Randomization Unit
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
Based on an analysis of microdata from Wisconsin and state-level and national data from KFF, we estimate at least at least 509,000 people, or about 425,000 households, will meet the inclusion criteria.
Sample size: planned number of observations
509,000 people
Sample size (or number of clusters) by treatment arms
Live outbound call from a Navigator 13,500 households
Pre-recorded outbound call 100,000 households
No-outreach control arm At least 311,000 households
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Based on this sample size and the projected division of households across treatment arms, the study will have 80% power to detect impacts of the live call on Medicaid coverage within 6 months as small as 1.2 percentage points, impacts of the pre-recorded call as small as 0.5 percentage points, and differences between the live and pre-recorded calls as small as 1.3 percentage points.

Institutional Review Boards (IRBs)

IRB Name
University of Wisconsin-Madison IRB
IRB Approval Date
IRB Approval Number