Clinical trial NCT05327712: Using Emails and Personalized Phone Calls to Increase Affordable Care Act Marketplace Enrollment Among Households Losing Medicaid
Official title: Using Emails and Personalized Phone Calls to Increase Affordable Care Act Marketplace Enrollment Among Households Losing Medicaid
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Health Behavior
Keywords: Affordable Care Act
randomized controlled trial
Medicaid
Lead sponsor: Office of Evaluation Sciences
Sponsor class: FED
First posted: 2022-04-14
Enrollment: 2173
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

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.


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.

Primary outcomes:
measure: Percent of households enrolled in an ACA plan by the end of the October 2017
timeFrame: Two months
Secondary outcomes:
Other outcomes:
Locations:
city: Sacramento
country: United States
facility: Covered California
state: California
Study officials:
affiliation: Covered California
name: Andrew Feher, PhD
role: PRINCIPAL_INVESTIGATOR
References: