Using Emails and Personalized Phone Calls to Increase Affordable Care Act Marketplace Enrollment Among Households Losing Medicaid

NCT ID: NCT05327712

Last Updated: 2022-06-16

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 2173 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-08-30
• Study Completion Date: 2017-11-17

Brief Summary

Since its passage in 2010, the Affordable Care Act (ACA) has helped reduce the uninsured rate to record lows, but changes in insurance coverage over time, known as churn, remain a concern. A recent survey found that nearly 25 percent of respondents reported a change in coverage over the previous twelve months. Among the most common reasons for churn is the loss of Medicaid eligibility, placing low-income populations at risk of a coverage gap. To date, little evidence exists on effective strategies states can use to facilitate Medicaid to Marketplace coverage transitions, an issue that has become more pressing amid projections that upwards of 15 million people could lose Medicaid eligibility once the COVID-19 public health emergency expires.

To address this gap and to inform Marketplace administrators, during a Special Enrollment Period (SEP) in 2017 in California's ACA Marketplace, we conducted a randomized controlled trial to examine the effect of email reminders, personalized telephone outreach, as well as the combination of the two forms of outreach on ACA enrollment among households who recently lost Medicaid and became eligible for subsidized Marketplace coverage.

During the SEP at the end of August 2017, the investigators randomly assigned households to one of four arms based on the last digit of their household identifier: a control group assigned to receive no outreach beyond an initial eligibility determination notice; an email-only group assigned to receive an initial eligibility determination plus email reminders about signing up for marketplace coverage; a phone-only group assigned to receive an initial eligibility determination plus a phone call offering enrollment assistance from a service center representative (SCR); a phone + email group assigned to receive an initial eligibility determination, email reminders about signing up for marketplace coverage and a phone call offering enrollment assistance.

Conditions

Health Behavior

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: OTHER
• Blinding Strategy: SINGLE

Study Groups

Control

The control group was assigned to receive no outreach beyond an initial eligibility determination notice

Group Type: EXPERIMENTAL

Control group

Intervention Type: BEHAVIORAL

No outreach during the intervention period beyond an initial eligibility notice.

Email-only

An email-only group assigned to receive an initial eligibility determination plus email reminders about signing up for marketplace coverage

Group Type: EXPERIMENTAL

Email only

Intervention Type: BEHAVIORAL

Email reminders in addition to an initial eligibility notice.

Phone-only

A phone-only group assigned to receive an initial eligibility determination plus a phone call offering enrollment assistance from a service center representative (SCR);

Group Type: EXPERIMENTAL

Phone only

Intervention Type: BEHAVIORAL

Phone call offering enrollment assistance in addition to an initial eligibility notice.

Phone and email

A phone + email group assigned to receive an initial eligibility determination, email reminders about signing up for marketplace coverage and a phone call offering enrollment assistance.

Group Type: EXPERIMENTAL

Phone and email

Intervention Type: BEHAVIORAL

Phone call and email reminders in addition to an initial eligibility notice.

Interventions

Control group

No outreach during the intervention period beyond an initial eligibility notice.

Intervention Type: BEHAVIORAL

Email only

Email reminders in addition to an initial eligibility notice.

Intervention Type: BEHAVIORAL

Phone only

Phone call offering enrollment assistance in addition to an initial eligibility notice.

Intervention Type: BEHAVIORAL

Phone and email

Phone call and email reminders in addition to an initial eligibility notice.

Intervention Type: BEHAVIORAL

Other Intervention Names

No outreach

Eligibility Criteria

Inclusion Criteria

• Those who recently lost Medicaid eligibility and became eligible for subsidized Affordable Care Act coverage

Exclusion Criteria

• Those who recently lost Medicaid eligibility and were found ineligible for subsidies.

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Office of Evaluation Sciences

FED

Sponsor Role: lead

Responsible Party

Andrew Feher

Research Scientist

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Andrew Feher, PhD

Role: PRINCIPAL_INVESTIGATOR

Covered California

Locations

Covered California

Sacramento, California, United States

Countries

United States

References

Ravel K, Ahrary J, Avakian K, Feher A, Menashe I. Effect of Personalized Outreach on Medicaid to Marketplace Coverage Transitions: A Randomized Clinical Trial. JAMA Health Forum. 2022 Oct 7;3(10):e223616. doi: 10.1001/jamahealthforum.2022.3616.

Reference Type: DERIVED

PMID: 36239955 (View on PubMed)

Other Identifiers

042022

Identifier Type: -

Identifier Source: org_study_id