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

Last registered on November 11, 2024

Pre-Trial

General Information

Title

RCT ID

AEARCTR-0013617

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

November 11, 2024, 12:20 PM EST

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

Locations

Country

United States of America

Region

Wisconsin

Primary Investigator

Name

Rebecca Myerson

Affiliation

University of Wisconsin-Madison

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

Laura Dague

PI Affiliation

Texas A&M

Contact Investigator

PI Name

Allison Espeseth

PI Affiliation

Covering Wisconsin

Contact Investigator

Additional Trial Information

Status

In development

Start date

2024-12-09

End date

2026-07-20

Keywords

Health

Additional Keywords

Medicaid, administrative burden, procedural denial

JEL code(s)

Secondary IDs

Prior work

This trial does not extend or rely on any prior RCTs.

Abstract

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 130,000 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

Citation

Myerson, Rebecca, Laura Dague and Allison Espeseth. 2024. "Enrollment Barriers, Procedural Denials, and Loss of Medicaid Coverage: A Randomized Trial to Identify Effective Outreach Solutions." AEA RCT Registry. November 11. https://doi.org/10.1257/rct.13617-3.0

Sponsors & Partners

Interventions

Intervention(s)

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, a pre-recorded message will be left identical to the pre-recorded call arm.

Pre-recorded call arm: Households in this arm will receive an outbound call message with a hotline number and 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 (Hidden)

Intervention Start Date

2024-12-09

Intervention End Date

2026-07-20

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

The experimental population will include people in Wisconsin who lost Medicaid coverage for procedural reasons during an 18 month period. 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. 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

Randomization Method

Randomization done in office by a computer

Randomization Unit

Household

Was the treatment clustered?

Yes

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 around 130,000 households will meet all the inclusion criteria.

Sample size: planned number of observations

156,000 people

Sample size (or number of clusters) by treatment arms

Live outbound call from a Navigator 13,500 households
Pre-recorded outbound call (45% of the sample) ~58,000 households
No-outreach control arm ~58,000 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 1.3 percentage points, impacts of the pre-recorded call as small as 0.8 percentage points, and differences between the live and pre-recorded calls as small as 1.3 percentage points.

Supporting Documents and Materials

IRB