| Field | Before | After |
|---|---|---|
| Field Abstract | 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. This research will identify novel, scalable outreach methods to help low-income people maintain access to benefits. | 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 experimental arms vary a) the modality of outreach message (text, postcard, and/or outbound call), b) the number of outreach messages (1 vs. 2), and c) for text messages, the channel offered to connect with assistance (texting with a chatbot first vs. directly calling a hotline to speak with a navigator). This research will identify novel, scalable outreach methods to help low-income people maintain access to benefits. |
| Field Trial Start Date | Before April 02, 2023 | After May 15, 2023 |
| Field Trial End Date | Before March 30, 2024 | After June 10, 2024 |
| Field Last Published | Before April 25, 2023 02:07 PM | After May 15, 2023 05:44 PM |
| Field Intervention (Public) | 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. 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. | 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, and/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, and the number of outreach messages (1 vs. 2). 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. |
| Field Intervention Start Date | Before April 02, 2023 | After May 15, 2023 |
| Field Intervention End Date | Before March 30, 2024 | After June 10, 2024 |
| Field Primary Outcomes (End Points) | Before 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. | After The primary outcome is maintenance of Medicaid enrollment, measured on the individual level over the 12 months following each person’s redetermination deadline (measured at 1, 3, 6, 9, and 12 months following each person’s redetermination deadline). |
| Field Experimental Design (Public) | Before 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. | 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 end of the continuous coverage provision, 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, half of the full sample will receive an outbound call. 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, and the number of outreach messages (1 vs. 2). Randomization will be stratified by the following factors: the preferred language of the primary person on the case, key Medicaid eligibility categories particularly relevant to ease of renewal, defined at the case level at baseline (being aged or disabled, being part of the “transitional medical assistance” population, or having eligibility due to pregnancy), whether there are enrolled children in the case at baseline, whether there are enrolled people over age 50 in the case at baseline, rural/urban residency of the primary person on the case, Black race and tribal membership of the primary person on the case. |
| Field Sample size (or number of clusters) by treatment arms | Before 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 | After 33,600 clusters in Arms A and B, and 12,600 clusters in arms C through J |
| Field Intervention (Hidden) | Before 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, text COVER to 920-507-5295 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. | After |
| Field Secondary Outcomes (End Points) | Before 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. | After The first set of secondary outcomes are proxies for whether the outreach was received. These measures include vendor data on text bouncebacks, invalid addresses, and feedback from an address and phone number validation service on whether the intended recipient was no longer reachable at the address or phone number provided by DHS. We will measure whether individuals who were sent a text message replied STOP, or DONE, the latter being a self-reported indicator of having taken action to renew their coverage. We will also measure whether recipients sent any reply message to the text, as a measure of engagement with the intervention. The second set of secondary outcomes focus on application activities and outcomes, measured using administrative data. We will use the following categories: no application on record; application started but not filed; application filed but denied due to lack of eligibility; application filed but denied due to administrative reasons; application accepted. These will be measured 15, 30, and 45 days after the information was sent to vendors, and 15, 30, and 45 days after the vendor sent the messages to recipients. Exploratory outcomes include SNAP enrollment, employment, and logged quarterly wages (+$1, to avoid taking the log of zero for those who are unemployed). These outcomes will also be measured at 1, 3, 6, 9, and 12 months after each person’s redetermination deadline. 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 the outreach messages were sent. |
| Field | Before | After |
|---|---|---|
| Field Document | Before |
After
Pre-analysis plan V13 05152023.docx
MD5:
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SHA1:
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| Field | Value |
|---|---|
| Field Document |
Value
Pre-analysis plan V10 04252023_clean.docx
MD5:
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SHA1:
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