Phone Outreach Nudges Among Individuals Losing Medicaid Coverage

Evaluating Impact of Outreach Nudges Among Individuals Losing Medicaid Coverage in California

In May 2023, Covered California, California's ACA marketplace, implemented its automatic enrollment program for individuals losing Medicaid coverage, as defined by Senate Bill 260. If individuals are found eligible for subsidized marketplace coverage, individuals will be automatically enrolled in the lowest cost silver plan available to them, but individuals must still take action to confirm their plan or pay their first month's premium. To identify whether the phone outreach is the effective outreach strategy to increase take-up in this population, Covered California implemented this intervention. The results of this evaluation will inform operational and budgeting decisions.

Study Overview

• Status: Enrolling by invitation
• Conditions: Behavioral Economics; Health Insurance
• Intervention / Treatment: Behavioral: Standard Notice; Behavioral: Phone Outreach

• Study Type: Interventional
• Enrollment (Estimated): 60045
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Sacramento, California, United States, 95835
      • Covered California

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Lost Medi-Cal (California's Medicaid coverage) in July 2023-June 2024
• Auto-enrolled into lowest cost silver plan with Covered California as per Senate Bill 260 and have not opted-in (effectuated) into the coverage
• Have a valid phone number on the health insurance application
• Do not have a delegated agent to their case
• Still have Covered California Program eligibility, not reverted back to Medi-Cal coverage
• Have English or Spanish as preferred speaking language

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Control Group without a phone call; Control Group was assigned to receive no phone outreach	Behavioral: Standard Notice; Standard notification letter without phone outreach to individuals losing Medicaid and auto-enrolled into Covered California plan to nudge them to act
Experimental: Treatment Group with a phone call; Treatment group was assigned to receive a phone call from Covered California call center	Behavioral: Phone Outreach; Phone outreach to individuals losing Medicaid and auto-enrolled into Covered California plan to nudge them to act

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health Plan Effectuation	A binary indicator for whether a consumer is effectuated into (paid for, opt-in into) Covered California plan, either the plan assigned through the auto-enrollment process, or into another plan chosen by the consumer by the end of the month at which outreach was conducted	within 30 days from the start date of plan they are auto-enrolled into

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tenure with Covered California (measured in months)	A length of tenure with Covered California plan within calendar year and/or beyond	measured 1-2 years after the intervention
Office visit	A binary indicator for whether someone had an office visit during 1-2 years since the intervention	measured 1-2 years after the intervention
Prescriptions filled	A binary indicator for whether someone had a prescription drug fill during 1-2 years since the intervention	measured 1-2 years after the intervention
Emergency Room Visit	A binary indicator for whether someone had an emergency room visit during 1-2 years since the intervention	measured 1-2 years after the intervention
Hospital admission	A binary indicator for whether someone had a hospital admission 1-2 years before and 1-2 years after the intervention	1-2 years before and after the intervention
Out-of-pocket spending on healthcare services	Total out-of-pocket spending for the 1-2 years since the intervention	measured 1-2 years after the intervention
Uninsured	A binary indicator for whether someone self-reported being uninsured while filing their taxes	measured 1-2 years after the intervention

Collaborators and Investigators

• Sponsor: Covered California
• Investigators: Principal Investigator: Emory Wolf, MPP, Covered California

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2023
• Primary Completion (Estimated): September 1, 2024
• Study Completion (Estimated): November 1, 2024

Study Registration Dates

• First Submitted: June 5, 2024
• First Submitted That Met QC Criteria: June 10, 2024
• First Posted (Actual): June 12, 2024

Study Record Updates

• Last Update Posted (Actual): June 12, 2024
• Last Update Submitted That Met QC Criteria: June 10, 2024
• Last Verified: June 1, 2024

More Information

Terms related to this study

• Keywords: Behavioral Economics; Nudge; Health Insurance; ACA marketplace
• Other Study ID Numbers: SB260-OCC-2023

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: 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.
• IPD Sharing Time Frame: Data will be available with investigator support upon publication
• IPD Sharing Access Criteria: Replication data can be accessed via request to the primary investigator upon publication.
• IPD Sharing Supporting Information Type: SAP

Drug and device information, study documents

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