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

Health Behavior Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05327712
• Other study ID #: 042022
• Status: Completed
• Phase: N/A
• Start date: August 30, 2017
• Est. completion date: November 17, 2017

Study information

• Verified date: June 2022
• Source: Office of Evaluation Sciences
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 2173
• Est. completion date: November 17, 2017
• Est. primary completion date: October 30, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

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.

Related Conditions & MeSH terms

• Health Behavior

Intervention

Behavioral:
• Control group
No outreach during the intervention period beyond an initial eligibility notice.
• Email only
Email reminders in addition to an initial eligibility notice.
• Phone only
Phone call offering enrollment assistance in addition to an initial eligibility notice.
• Phone and email
Phone call and email reminders in addition to an initial eligibility notice.

Locations

Country	Name	City	State
United States	Covered California	Sacramento	California

Sponsors (1)

Lead Sponsor	Collaborator
Office of Evaluation Sciences

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percent of households enrolled in an ACA plan by the end of the October 2017	Percent of households enrolled in an ACA plan during the intervention period	Two months