Outreach and Maintenance of Medicaid Enrollment: Evidence from Wisconsin’s Navigator Program

Last registered on December 12, 2022

Pre-Trial

Trial Information

General Information

Title
Outreach and Maintenance of Medicaid Enrollment: Evidence from Wisconsin’s Navigator Program
RCT ID
AEARCTR-0009772
Initial registration date
August 09, 2022

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
August 09, 2022, 5:04 PM EDT

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

Last updated
December 12, 2022, 2:41 PM EST

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

Locations

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Primary Investigator

Affiliation
University of Wisconsin-Madison

Other Primary Investigator(s)

PI Affiliation
Texas A&M

Additional Trial Information

Status
In development
Start date
2023-04-02
End date
2024-03-30
Secondary IDs
NCT05433454
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
For many government safety net programs, beneficiaries must regularly demonstrate eligibility to avoid losing benefits. The objective of this field experiment is to identify the effect of outreach strategy on beneficiaries’ maintenance of Medicaid enrollment. The topic is timely because an upcoming policy change after the end of the COVID-19 public health emergency (PHE) will increase demonstration of eligibility requirements for Medicaid beneficiaries nationwide. The experimental population includes an estimated 168,000 cases (members of a household who applied for Medicaid together) in Wisconsin enrolled in fee-for-service Medicaid who must renew or lose their coverage after the end of the public health emergency. The implementing organization is Covering Wisconsin, the navigator organization contracted by the Wisconsin Department of Health Services to conduct outreach to these beneficiaries. The intervention arms will vary the modality of outreach (postcard, text message, or outbound call), the content of the outreach (encouraging a call to a hotline vs. encouraging a text message that connects them with a chatbot) offered, the number of outreach messages (1 vs. 2), and the use of an address and phone number updating service prior to outreach. This research will identify novel, scalable outreach methods to help low-income people maintain access to benefits.
External Link(s)

Registration Citation

Citation
Myerson, Rebecca and Laura Dague. 2022. "Outreach and Maintenance of Medicaid Enrollment: Evidence from Wisconsin’s Navigator Program." AEA RCT Registry. December 12. https://doi.org/10.1257/rct.9772-2.8
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
This field experiment will test methods to increase maintenance of Medicaid enrollment by connecting beneficiaries with navigators, a group of professionals publicly funded since 2014 to help consumers enroll in coverage. The intervention will be implemented by Covering Wisconsin, a navigator grantee with a staff of more than a dozen professional assisters. Covering Wisconsin was contracted by the Wisconsin Department of Health Services (DHS) to conduct outreach to fee-for-service Medicaid beneficiaries after the end of the public health emergency.
The intervention arms will vary the modality of outreach (postcard, text message, or outbound call), content of the outreach (encouraging a call to a hotline vs. encouraging a text message that connects them with a chatbot) offered, the number of outreach messages (1 vs. 2), and the use of an address and phone number updating service prior to outreach. These interventions will be repeated after the renewal window closes for people who lost their coverage. All beneficiaries will also be mailed standard letters by DHS.
Intervention Start Date
2023-04-02
Intervention End Date
2024-03-30

Primary Outcomes

Primary Outcomes (end points)
The primary outcome is maintenance of Medicaid enrollment, measured on the individual level over the 12 months following each person’s redetermination deadline (e.g., at 1, 3, 6, 9, and 12 months; successful redetermination at 12 months). When analyzing data from the second round of outreach (i.e., for people who had already lost their coverage), outcomes will be measured at 1, 3, 6, 9, and 12 months after at the time of the receipt of outreach messages.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary outcomes focus on application activities and outcomes, measured using the following categories: no application filed; application filed but denied due to lack of eligibility; application filed but denied due to administrative reasons; application accepted. Additional secondary outcomes include SNAP enrollment, employment, and logged quarterly wages (+$1, to avoid taking the log of zero for those who are unemployed). Outcomes will be measured at 1, 3, 6, 9, and 12 months after each person’s redetermination deadline.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study population includes all fee-for-service Medicaid beneficiaries in Wisconsin, except those who prefer a language other than English or Spanish, lack any phone number, or are missing a mailing address.

Assignment to treatment arms will occur monthly over the 12-month period after the PHE, to ensure each beneficiary receives outreach at the beginning of their two-month redetermination window assigned by the state. Each month, Wisconsin DHS will provide Covering Wisconsin a list of the beneficiaries whose redetermination window begins. Randomization for people in each group of monthly renewals will be clustered by case (e.g., members of a household who applied for Medicaid together) to address potential spillovers.

40% of cases will be assigned to be sent a postcard, and the remaining 60% of cases will be assigned to the text message arms, with 30% receiving a message with a text message call to action and 30% receiving a message with a hotline call to action. In addition, 30% of the full sample (10% of the group assigned to a postcard and 5% of each group assigned to a text message) will be placed on the waitlist to potentially receive an outbound call. Finally, an address updating service will be used to refresh address and phone numbers for 50% of the study sample.

There will be a second round of randomization to determine outreach strategy for people who lost their Medicaid coverage during the redetermination process. As in the first round of randomization, cases will be assigned to receive outreach messages that vary the modality of outreach (postcard, text message, or outbound call), content of the outreach (encouraging a call to a hotline vs. encouraging a text message that connects them with a chatbot) offered, the number of outreach messages (1 vs. 2), and use of an address and phone number updating service prior to outreach. The assignment process for this second round of randomization will follow the same process described above.
Experimental Design Details
Not available
Randomization Method
Randomization will be done in office using a computer.
Randomization Unit
Randomization for people in each group of monthly renewals will be clustered by case (e.g., members of a household who applied for Medicaid together) to address potential spillovers.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
168,000
Sample size: planned number of observations
224,000
Sample size (or number of clusters) by treatment arms
50,400 clusters in Arm A, 16,800 in Arm B, 16,800 in Arm C, 16,800 in Arm D, 8,400 in Arm E, 8,400 in F, 16,800 in Arm G, 16,800 in Arm H, 8,400 in Arm I, and 8,400 in Arm J
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The study has 80% power to detect a 0.69 percentage point change in enrollment rates due to changes in outreach repetition or suggested modality for contact.
IRB

Institutional Review Boards (IRBs)

IRB Name
University of Wisconsin-Madison Institutional Review Board
IRB Approval Date
2022-09-12
IRB Approval Number
2022-0806
Analysis Plan

Analysis Plan Documents

Pre-analysis plan V4 12122022.docx

MD5: 61353b861bb41c407811ae8c3e8848ad

SHA1: 6d6d2aa2469c508997d81583ddaff2c76369453a

Uploaded At: December 12, 2022