Using Emails and Personalized Phone Calls to Increase Affordable Care Act Marketplace Enrollment Among Households Losing Medicaid
1 other identifier
interventional
2,173
1 country
1
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.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Aug 2017
Shorter than P25 for not_applicable
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
Study Start
First participant enrolled
August 30, 2017
CompletedPrimary Completion
Last participant's last visit for primary outcome
October 30, 2017
CompletedStudy Completion
Last participant's last visit for all outcomes
November 17, 2017
CompletedFirst Submitted
Initial submission to the registry
April 7, 2022
CompletedFirst Posted
Study publicly available on registry
April 14, 2022
CompletedJune 16, 2022
June 1, 2022
2 months
April 7, 2022
June 13, 2022
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
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
Study Arms (4)
Control
EXPERIMENTALThe control group was assigned to receive no outreach beyond an initial eligibility determination notice
Email-only
EXPERIMENTALAn email-only group assigned to receive an initial eligibility determination plus email reminders about signing up for marketplace coverage
Phone-only
EXPERIMENTALA phone-only group assigned to receive an initial eligibility determination plus a phone call offering enrollment assistance from a service center representative (SCR);
Phone and email
EXPERIMENTALA 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.
Interventions
No outreach during the intervention period beyond an initial eligibility notice.
Phone call offering enrollment assistance in addition to an initial eligibility notice.
Phone call and email reminders in addition to an initial eligibility notice.
Eligibility Criteria
You may qualify if:
- Those who recently lost Medicaid eligibility and became eligible for subsidized Affordable Care Act coverage
You may not qualify if:
- Those who recently lost Medicaid eligibility and were found ineligible for subsidies.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
Covered California
Sacramento, California, 95815, United States
Related Publications (1)
Ravel K, Ahrary J, Avakian K, Feher A, Menashe I. Effect of Personalized Outreach on Medicaid to Marketplace Coverage Transitions: A Randomized Clinical Trial. JAMA Health Forum. 2022 Oct 7;3(10):e223616. doi: 10.1001/jamahealthforum.2022.3616.
PMID: 36239955DERIVED
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Andrew Feher, PhD
Covered California
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- SINGLE
- Who Masked
- PARTICIPANT
- Purpose
- OTHER
- Intervention Model
- PARALLEL
- Sponsor Type
- FED
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Research Scientist
Study Record Dates
First Submitted
April 7, 2022
First Posted
April 14, 2022
Study Start
August 30, 2017
Primary Completion
October 30, 2017
Study Completion
November 17, 2017
Last Updated
June 16, 2022
Record last verified: 2022-06
Data Sharing
- IPD Sharing
- Will share
- Shared Documents
- STUDY PROTOCOL, ANALYTIC CODE
- Time Frame
- Data will be available with investigator support upon publication.
- Access Criteria
- Replication data can be accessed via request to the primary investigator upon publication.
The researchers are committed to sharing as much data as possible for replication, consistent with the privacy and security requirements of the state agency that govern the re-disclosure of the data.