Impact of Outreach on Medicaid Enrollment

Outreach and Maintenance of Medicaid Enrollment: Evidence From Wisconsin's Navigator Program

This project will assess the impact of various forms of outreach from navigators on Medicaid enrollment. Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The investigators propose to randomize the nature of outreach to households in Wisconsin enrolled in fee-for-service Medicaid who must renew or lose their coverage.

Study Overview

• Status: Active, not recruiting
• Conditions: Health Insurance
• Intervention / Treatment: Other: Outreach From Navigators

Detailed Description

During the COVID-19 public health emergency, states received support to maintain continuous Medicaid coverage, raising Medicaid enrollment to unprecedented levels. In Wisconsin, enrollment was nearly 30% higher by the end of 2021 compared to February 2020, with the maintenance of enrollment policy contributing to much of this increase. After the end of the public health emergency, normal renewal processes will resume.

The Wisconsin navigator program, Covering Wisconsin, has been commissioned by the Department of Health Services (DHS) to conduct outreach to the group of fee-for-service Medicaid beneficiaries who need to re-determine eligibility after the conclusion of the public health emergency. To identify what outreach strategies are most effective, the investigators propose to randomize the nature of outreach used. While there will be some variation in the content and timing of messages, all beneficiaries will receive messages with clear information on how to contact the navigators.

Per a protocol amendment approved on 2/21/24, the study team will no longer randomize receipt of an outbound call but rather will provide it to all participants.

• Study Type: Interventional
• Enrollment (Actual): 119308
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Wisconsin
    • Madison, Wisconsin, United States, 53705
      • University of Wisconsin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Included on the lists Wisconsin DHS provides to Covering Wisconsin of fee-for-service Medicaid beneficiaries who need to renew their Medicaid coverage

Exclusion Criteria:

• Prefer a language other than English or Spanish or lack a cellular phone number

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

10

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Outreach via Postcard; 40 percent of the sample	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach via Postcard + Outbound Call; Outreach via postcard, plus placed an outbound phone call from navigators (20% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach via Text Message Encouraging Call to Hotline; Outreach via text message encouraging a call to a hotline for assistance (15% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach via Text Message Encouraging Call to Hotline + Outbound Call; Outreach via text message encouraging a call to a hotline for assistance, plus outbound phone call from navigators (7.5% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach via Text Message Encouraging Text Reply To Connect with Navigators; Outreach via text message encouraging a text reply to connect with navigators via chatbot (15% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach via Text Message Encouraging Text Reply To Connect with Navigators + Outbound Call; Outreach via text message encouraging a text reply to connect with navigators via chatbot, plus an outbound phone call from navigators (7.5% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach via Text Message Encouraging a Call to a Hotline for Assistance + a Reminder Message; Outreach via text message encouraging a call to a hotline for assistance plus a similar reminder message two weeks later (15% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach Text Message Encouraging Call a Hotline for Assistance + Reminder Message; Outreach via text message encouraging a call to a hotline for assistance plus a similar reminder message two weeks later + outbound call (7.5% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach via Text Message Encouraging Text Reply To Connect with Navigators+ a Reminder Message; Outreach via text message encouraging a text reply to connect with navigators via chatbot plus a similar reminder message two weeks later (15% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.
Experimental: Outreach via Text Message Encouraging Reply To Connect with Navigators + Reminder Message; Outreach via text message encouraging a text reply to connect with navigators via chatbot plus a similar reminder message two weeks later + outbound call (7.5% of sample)	Other: Outreach From Navigators; Navigators are professionals who can provide one-on-one assistance with the Medicaid renewal process. The nature of the outreach will be randomized to participants.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of Participants Who Renew Medicaid Coverage	up to 1 year

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Who Submit an Application to Renew Medicaid Coverage		up to 1 year
Number of Participants for Whom Application to Renew Medicaid Coverage is Denied for Administrative Reasons		up to 1 year
Demographics of People who Renew Medicaid Coverage	The investigators will measure the characteristics of people who renew medicaid coverage, including baseline income, race/ethnicity, and language preference.	up to 1 year
Number of Participants Responding 'DONE' to Text Message Outreach		up to 1 year
Survey of Participants Who Received an Outbound Call Reported in Count of Participants	People who received an outbound call will be asked whether they finished an application to renew their coverage or receive new coverage, and whether they received a text message or postcard with a reminder and information about how to get help.	up to 1 year

Collaborators and Investigators

• Sponsor: University of Wisconsin, Madison
• Collaborators: Covering Wisconsin
• Investigators: Principal Investigator: Rebecca Myerson, MPH, PhD, UW-Madison School of Medicine and Public Health

Study record dates

Study Major Dates

• Study Start (Actual): May 17, 2023
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): May 1, 2026

Study Registration Dates

• First Submitted: June 21, 2022
• First Submitted That Met QC Criteria: June 21, 2022
• First Posted (Actual): June 27, 2022

Study Record Updates

• Last Update Posted (Estimated): December 12, 2025
• Last Update Submitted That Met QC Criteria: December 11, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Medicaid; Enrollment; Outreach
• Other Study ID Numbers: 2022-0806; A538500 (Other Identifier: UW- Madison); SMPH/POP HEALTH SCI/POP HLTH (Other Identifier: UW- Madison); Protocol Amend 2/21/2024 (Other Identifier: UW Madison)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No