| Field | Before | After |
|---|---|---|
| Field Abstract | Before 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. | After 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 289,000 people (170,000 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. |
| Field Last Published | Before June 30, 2025 03:36 PM | After July 01, 2025 01:27 PM |
| Field Experimental Design (Public) | Before 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. Randomization will be stratified by key characteristics that can affect eligibility and enrollment processes. To maximize power to detect an effect among non-English speakers, which are a small minority of the sample, we will randomize households whose head preferred a language other than English to the three treatment arms in equal numbers. English speakers will be randomized to remaining live outbound call spots until the capacity cap is hit, and remaining English-speaking households will be assigned to the remaining two treatment arms (pre-recorded call and control group) in equal proportions. To reflect this randomization strategy, we will separately analyze data for English and non-English speakers. | After 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. Randomization will be stratified by key characteristics that can affect eligibility and enrollment processes. Households will be equally assigned across the three treatment arms starting in July 2025, the fifth month of the study; this reflects increasing capacity of navigators to make outbound calls in the early months of the study. In the first month, 750 live calls were placed. In the second month 1500 live calls were placed. In the third and fourth months, we were able to increase that number to 2,000 calls per month and 2,500 calls per month, respectively, as it became clear that there was capacity to place more live calls. (In a treatment on the treated analysis, we will account for the possibility that if the call list is particularly long in a given month, not everyone on the list will receive an outbound call.) |
| Field Planned Number of Observations | Before 156,000 people | After Based on the number of people who lost Medicaid coverage each month for procedural reasons during the first few months of trial implementation, we anticipate there will be 169,692 households (288,738 people) in the study sample once the full 18-month outreach period is complete. |
| Field Sample size (or number of clusters) by treatment arms | Before Live outbound call from a Navigator ~36,000 households Pre-recorded outbound call ~47,000 households No-outreach control arm ~47,000 households | After Live outbound call from a Navigator ~47,000 households Pre-recorded outbound call ~61,000 households No-outreach control arm ~61,000 households |
| Field Power calculation: Minimum Detectable Effect Size for Main Outcomes | Before 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 0.9 percentage points, impacts of the pre-recorded call as small as 0.9 percentage points, and differences between the live and pre-recorded calls as small as 1.0 percentage points. | After 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 0.76 percentage points, impacts of the pre-recorded call as small as 0.68 percentage points, and differences between the live and pre-recorded calls as small as 0.76 percentage points. These calculations account for clustering by household (i.e., one person is contacted in each household, and the outcomes of people within the household are related). The calculations do not factor in the efficiency gains from incorporating covariates in the model, and thus are likely conservative (i.e., the true minimum detectable effect size is likely smaller). |
| Field Secondary Outcomes (End Points) | Before Secondary outcomes include Medicaid coverage during the 6 months after the renewal deadline (measured each month); the duration of any coverage gaps up to 6 months after the renewal deadline; whether the individual spoke with Covering Wisconsin either by calling the hotline or receiving a live outbound call; whether the individual called the Covering Wisconsin hotline; and whether someone used any health care covered by Medicaid in the 3 months or 6 months after the renewal deadline. | After Secondary outcomes include Medicaid coverage during the 6 or 12 months after the renewal deadline (measured each month); the duration of any coverage gaps up to 6 or 12 months after the renewal deadline; whether the individual spoke with Covering Wisconsin either by calling the hotline or receiving a live outbound call; whether the individual called the Covering Wisconsin hotline; and whether someone used any health care covered by Medicaid in the 3 months, 6 months, or 12 months after the renewal deadline. |
| Field | Before | After |
|---|---|---|
| Field Document | Before |
After
Pre-analysis plan v07012025.docx
MD5:
d761004edb92caebf0498cc422b203b8
SHA1:
6ca9935223c4c21e936e2494f3425e7d3dbcfa6b
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