Impact of Outreach on Medicaid Coverage Outcomes for People with Procedural Denials

• In Event: Expanding Coverage, Ensuring Access: Challenges in Public Insurance

Abstract

Millions of Medicaid enrollees must redemonstrate their eligibility for the program annually, often resulting in loss of Medicaid coverage due to procedural reasons (i.e., due to administrative issues such as missing paperwork, deadlines, or other procedural errors). In 2023, more than 9 million U.S. residents lost Medicaid coverage for procedural reasons. The goal of this randomized controlled trial is to reduce avoidable gaps in coverage who lost their coverage for procedural reasons through targeted outreach interventions that provide one-on-one assistance from a health insurance Navigator.

Objective and Research Questions

The primary objective of the study, which is already in the field since February 2025, is to assess the effectiveness of two different outreach methods in improving Medicaid enrollment. The research questions are:

1. Impact of Live Outreach: How does a live phone call from a Navigator affect Medicaid enrollment among individuals who lost coverage for procedural reasons?


2. Equity and Efficiency of Different Approaches: What is the incremental effectiveness and cost-effectiveness of live calls compared to pre-recorded calls, particularly in reaching underserved populations such as tribal members, people who are Black or Hispanic, or people preferring a language other than English?

The study employs a randomized controlled trial with three arms:

1. Live Outbound Call from a Navigator: 13,500 households will receive the offer of personalized assistance through live phone calls. If the respondent does not pick up, they will receive a voicemail identical to the pre-recorded call arm described below.


2. Pre-recorded Outbound Call: Approximately 58,000 households will receive pre-recorded messages providing information about Navigator assistance.


3. No-outreach Control Arm: Approximately 58,000 households will serve as the control group, receiving no outreach.

Households are randomized monthly, stratified by language preference, tribal membership, and specific demographic characteristics to ensure balanced representation. The primary outcome is successful Medicaid renewal within three months – which would ensure no gap in Medicaid coverage, given Wisconsin’s policy of backdating coverage if restored within 3 months. Secondary outcomes will include coverage during the six months post-renewal and the duration of coverage gaps. A treatment on the treated analysis will be conducted to measure the direct impact of the interventions on those who received them.

Expected Impact on Policy

The findings from this study have the potential to inform policy and practice at multiple levels. At the local and state level, data on the cost-effectiveness of outreach strategies can guide Navigator organizations in optimizing their efforts to assist Medicaid beneficiaries. At the federal level, evidence of the impact of Navigator outreach on Medicaid coverage can influence funding decisions and support the scaling up of effective interventions. Interim findings and the study design will be shared at the conference, along with the pre-analysis plan.

Authors

• Rebecca Myerson, Emory University
  Presenting Author

• Laura Dague, Texas A&M University
  Non-Presenting Co-Author