Evaluation of Randomized Medicaid Redetermination Assistance

• In Event: Effects of HR1 Implementation on Medicaid Enrollment and Mitigation Strategies

Abstract

Introduction/Background: Many people who remain eligible for Medicaid remain uninsured or lose coverage due to the administrative complexities inherent to the program’s enrollment and renewal processes. In partnership with the Louisiana Department of Health, we evaluated whether — and for whom — simple reminders and direct application can effectively prevent avoidable coverage loss among people the state could not automatically renew.

Study Design:We implemented a randomized controlled trial in which a subset of enrollees who could not be renewed on an automatic (ex parte) basis were assigned to one of two intervention arms. Those in the “simple reminder” received a phone call (and/or text) reminding them that they needed to take action to maintain their Medicaid benefits. Enrollees in the application assistance arm received telephone calls (and/or texts) from certified assisters offering support in completing the renewal application. The remaining enrollees, who did not receive additional outreach beyond standard state communications, comprised the control group. Our primary outcomes were return of renewal packets and successful renewal.

Results/FindingsCallers were able to reach (spoke to or left a voicemail for) slightly more than half of study enrollees for whom they attempted outreach. Among those enrollees callers spoke with, 60-80% reported that they had received their renewal form, with more enrollees reporting receipt closer to the renewal deadline.

Our simple outreach arm yielded modest improvements in our outcomes, on the order of a 3% relative boost in packet returns and a 2% relative boost in successful renewals. In the application assistance arm, packet returns increased approximately 6% on a relative basis and successful renewals increase 8-11% on a relative basis. There is suggestive evidence that simple reminders were more effective for child and young adult enrollees and those who identify as non-Hispanic White, and that application assistance was more effective for older (65+) and non-Hispanic Black enrollees.

Conclusion/Implications:Our findings suggest that higher-touch interventions that connect people directly to enrollment supports are better at preventing avoidable Medicaid coverage loss than low-touch (information only) interventions. Our simple reminder estimates are comparable to effects documented in similar settings that use automated phone calls (robocalls), which would be more cost-effective than our live callers.

With more frequent eligibility redeterminations and new work requirements likely to increase the risk of procedural disenrollment in 2027 and beyond, states may need to pair low-cost automated reminders with targeted, higher-touch assistance for enrollees at greatest risk of losing coverage. Strategically deploying enrollment supports could help preserve coverage continuity while containing administrative costs.

Author

• Adrianna McIntyre, Harvard University
  Presenting Author