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Field
Abstract
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Before
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; the chatbot can also be used to schedule a call with an assister. This research will identify novel, scalable outreach methods to help low-income people maintain access to benefits.
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After
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.
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Field
Last Published
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Before
November 21, 2022 03:44 PM
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After
November 21, 2022 05:14 PM
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Field
Intervention (Public)
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Before
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; the chatbot can also be used to schedule a call with an assister. 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.
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After
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.
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Field
Experimental Design (Public)
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Before
The study population includes all fee-for-service Medicaid beneficiaries in Wisconsin, except those who prefer a language other than English or Spanish or who lack a cellular phone number.
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.
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After
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.
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Field
Intervention (Hidden)
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Before
This is a four-arm research design. The experimental arms will vary he 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 to a list of beneficiaries whose redetermination window begins. Sample message content of the text messages is as follows, with the bracketed Call to Action text varying across arms: “Hi, this is nonprofit Covering WI, for the WI Dept of Health Services. Time to renew your BadgerCare or Medicaid! To get free, local help, [Call to Action] or visit www.coveringwi.org. STOP to end.” The treatment arms will be as follows:
Arm A: These consumers will be sent a postcard inviting them to speak with an assister by calling a hotline. The Call-to-Action text will be “call ###.”
Arm B: These consumers will be sent the same postcard as arm A and will be placed on a waitlist to receive an outbound call.
Arm C: These consumers will be sent a text message inviting them to speak with an assister by calling a hotline. The Call-to-Action text will be “call ###.”
Arm D: Text message as in arm C; these consumers are also sent a second reminder message two weeks after the initial message.
Arm E: Text message as in arm C; these consumers are also placed on a waitlist to receive an outbound call.
Arm F: Text message as in arm C; these consumers are also placed on a waitlist to receive an outbound call, and sent a second reminder message two weeks after the initial message.
Arm G: These consumers will be sent a text message inviting them to send a text message, which will connect them with a chatbot. The Call-to-Action text will be “text COVER to 920-###-####.”
Arm H: Text message as in arm G; these consumers will also receive a second reminder message two weeks after the first.
Arm I: Text message as in arm G; these consumers will also be placed on a waitlist to receive an outbound call.
Arm J: Text message as in arm G; these consumers will also receive a second reminder message and be placed on a waitlist to receive an outbound call.
Address Updating: 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 for people who lost their Medicaid because of the redetermination process. These consumers will receive a message text such as the following: “Hi, this is nonprofit Covering WI, for the WI Dept of Health Services. Lost your health insurance? To get free, local help, [Call to Action] or visit coveringwi.org. STOP to end.” The group will be split into additional treatment arms with varied modality of the 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 as in the first round of messaging.
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After
The experimental arms will vary he 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 to a list of beneficiaries whose redetermination window begins. Sample message content of the text messages is as follows, with the bracketed Call to Action text varying across arms: “Hi, this is nonprofit Covering WI, for the WI Dept of Health Services. Time to renew your BadgerCare or Medicaid! To get free, local help, [Call to Action] or visit www.coveringwi.org. STOP to end.” The treatment arms will be as follows:
Arm A: These consumers will be sent a postcard inviting them to speak with an assister by calling a hotline. The Call-to-Action text will be “call ###.”
Arm B: These consumers will be sent the same postcard as arm A and will be placed on a waitlist to receive an outbound call.
Arm C: These consumers will be sent a text message inviting them to speak with an assister by calling a hotline. The Call-to-Action text will be “call ###.”
Arm D: Text message as in arm C; these consumers are also sent a second reminder message two weeks after the initial message.
Arm E: Text message as in arm C; these consumers are also placed on a waitlist to receive an outbound call.
Arm F: Text message as in arm C; these consumers are also placed on a waitlist to receive an outbound call, and sent a second reminder message two weeks after the initial message.
Arm G: These consumers will be sent a text message inviting them to send a text message, which will connect them with a chatbot. The Call-to-Action text will be “text COVER to 920-###-####.”
Arm H: Text message as in arm G; these consumers will also receive a second reminder message two weeks after the first.
Arm I: Text message as in arm G; these consumers will also be placed on a waitlist to receive an outbound call.
Arm J: Text message as in arm G; these consumers will also receive a second reminder message and be placed on a waitlist to receive an outbound call.
Address Updating: 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 for people who lost their Medicaid because of the redetermination process. These consumers will receive a message text such as the following: “Hi, this is nonprofit Covering WI, for the WI Dept of Health Services. Lost your health insurance? To get free, local help, [Call to Action] or visit coveringwi.org. STOP to end.” The group will be split into additional treatment arms with varied modality of the 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 as in the first round of messaging.
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