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

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.

2023-04-02

2024-03-30

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.

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.

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.

Not available

Randomization will be done in office using a computer.

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.

Yes

168,000

224,000

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

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.

Pre-analysis plan V7 04032023 clean.docx