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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
Last updated
June 15, 2017 10:57 AM EDT
Location(s)
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 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, Katherine Baicker and Bill Wright. 2017. "Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon." AEA RCT Registry. June 15. http://www.socialscienceregistry.org/trials/2236/history/18578.
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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
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
January 31, 2014, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
January 31, 2014, 12:00 AM +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