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

Study Overview
=================
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.

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

Conditions
-----------------
Health Behavior

Intervention / Treatment
-----------------
* Behavioral: Control group
* Behavioral: Email only
* Behavioral: Phone only
* Behavioral: Phone and email


Participation Criteria
=================
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.
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Control<br>The control group was assigned to receive no outreach beyond an initial eligibility determination notice | Behavioral: Control group<br>* No outreach during the intervention period beyond an initial eligibility notice.<br>* Other names: No outreach;|
| Experimental: Email-only<br>An email-only group assigned to receive an initial eligibility determination plus email reminders about signing up for marketplace coverage | Behavioral: Email only<br>* Email reminders in addition to an initial eligibility notice.<br>|
| Experimental: Phone-only<br>A phone-only group assigned to receive an initial eligibility determination plus a phone call offering enrollment assistance from a service center representative (SCR); | Behavioral: Phone only<br>* Phone call offering enrollment assistance in addition to an initial eligibility notice.<br>|
| Experimental: Phone and email<br>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. | Behavioral: Phone and email<br>* Phone call and email reminders in addition to an initial eligibility notice.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Affordable Care Act, randomized controlled trial, Medicaid