Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon

Last registered on June 15, 2017

Pre-Trial

Trial Information

General Information

Title
Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon
RCT ID
AEARCTR-0002236
Initial registration date
June 13, 2017

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 15, 2017, 10:57 AM EDT

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

Locations

Primary Investigator

Affiliation
Harvard

Other Primary Investigator(s)

PI Affiliation
Center for Outcomes Research and Education of Providence Health and Services

Additional Trial Information

Status
Completed
Start date
2013-06-01
End date
2017-05-31
Secondary IDs
Abstract
Efforts to reduce the ranks of the uninsured hinge on take-up of available programs and subsidies, but take-up of even free insurance is often less than complete. The evidence of the effectiveness of policies aiming to increase take-up is limited. We used a randomized controlled design to evaluate the impact of improved communication and behaviorally informed "nudges" designed to increase Medicaid take-up among eligible populations. Fielding randomized interventions in two different study populations in Oregon, we found that even very low-cost interventions substantially increased enrollment. Effects were larger in a population whose members had already expressed interest in obtaining coverage, but the effects were more persistent in low-income populations whose members were already enrolled in other state assistance programs but had not expressed interest in health insurance. The effects were similar across different demographic groups. Our results suggest that improving the design of enrollment processes and using low-cost mass-outreach efforts have the potential to substantially increase insurance coverage of vulnerable populations.
External Link(s)

Registration Citation

Citation
Baicker, Katherine and Bill J. Wright. 2017. "Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon." AEA RCT Registry. June 15. https://doi.org/10.1257/rct.2236-1.0
Former Citation
Baicker, Katherine and Bill J. Wright. 2017. "Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon." AEA RCT Registry. June 15. https://www.socialscienceregistry.org/trials/2236/history/18578
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2013-09-01
Intervention End Date
2014-01-31

Primary Outcomes

Primary Outcomes (end points)
Medicaid enrollment rates
Primary Outcomes (explanation)
Subsequent analyses may examine Medicaid utilization

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Experiment 1: Throughout 2013, Oregon allocated a limited number of spots in OHP Standard – the state’s Medicaid expansion program for non-disabled adults with incomes up to 100% of FPL – by selecting names by lottery from a waiting list. Anyone selected had a 45 day window in which they could enroll; after that their application would not be accepted. We excluded individuals who were discovered to have moved out of state or already be enrolled in OHP through another avenue.

Experiment 2: Oregon’s Medicaid lottery ended when it chose to participate in the ACA Medicaid expansion in late 2013. As part of this expansion, in October 2013 the state launched an abbreviated “fast track” enrollment process for individuals presumed to be eligible for Medicaid because of participation in other means-tested programs, including households with active enrollment in the state’s SNAP (food stamps) or “Healthy Kids” program (a supplemental insurance program for children), but who were not enrolled in Medicaid. The “fast track” process consisted of simply signing and returning a form, foregoing the usual Medicaid application process because eligibility for the other programs had already been determined. Those who returned the form would be covered as of January 1, 2014 (although the forms could be returned until March 2014). Our study sample consisted of 159,015 members of the fast track list who had received an initial mailing from the state in September, but had not yet enrolled as of November.
Experimental Design Details
Randomization Method
Lottery
Randomization Unit
Individuals
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
N/A
Sample size: planned number of observations
Experiment 1: 883 individuals Experiment 2: 159,015 individuals
Sample size (or number of clusters) by treatment arms
Experiment 1: 291 individuals in the control group; 304 individuals in Low Intensity Intervention treatment group; 288 individuals in High Intensity Intervention treatment group
Experiment 2: 153,341 individuals in the control group; 5,674 individuals in the Enhanced Outreach Intervention treatment group
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Providence CORE
IRB Approval Date
Details not available
IRB Approval Number
Details not available

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
January 31, 2014, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
January 31, 2014, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
N/A
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
Experiment 1: 883 individuals
Experiment 2: 159,015 individuals
Final Sample Size (or Number of Clusters) by Treatment Arms
Experiment 1: 291 individuals in the control group; 304 individuals in Low Intensity Intervention treatment group; 288 individuals in High Intensity Intervention treatment group Experiment 2: 153,341 individuals in the control group; 5,674 individuals in the Enhanced Outreach Intervention treatment group
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
Citation
Bill J. Wright, Ginny Garcia-Alexander, Margarette A. Weller and Katherine Baicker. Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon. Health Affairs 36, no.5 (2017):838-845

Reports & Other Materials