Evaluating the Effect of Automatic Plan Assignment and Enhanced Outreach of Marketplace Take-up (MAPS)

Facilitated enrollment offers a potential solution to some administrative burdens and choice frictions that may produce incomplete take-up of marketplace coverage. Because Covered California, California's ACA individual marketplace, and Medi-Cal, California's Medicaid program, share an eligibility system, Covered California has the ability to identify individuals who are eligible for marketplace coverage upon losing Medicaid eligibility.

This evaluation will compare the effectiveness of facilitated enrollment strategies, including personalized plan pre-selection and personalized quotes of net premiums, to other enhanced, but general outreach tactics, on marketplace take-up among individuals losing Medi-Cal coverage.

Study Overview

• Status: Enrolling by invitation
• Conditions: Outreach Intervention
• Intervention / Treatment: Behavioral: Informational flyer; Behavioral: Modified eligibility notice with plan information

• Study Type: Interventional
• Enrollment (Estimated): 30000
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Sacramento, California, United States, 95620
      • Covered California

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Individual in a single-member household
• Discontinued from Medi-Cal
• Eligible for Covered California program
• Ineligible for APTCs on initial application
• Did not attest to planning to file taxes within their Covered California application

Exclusion Criteria:

• Consumer case is no longer active within the application system
• Consumer is already actively enrolled in a marketplace plan
• Consumer has already restored Medi-Cal eligibility
• A consumer's Special Enrollment Period has ended
• Consumer is no longer listed as a single-member household
• Consumer was procedurally denied from Medi-Cal coverage due to no response
• Consumers has a MAGI Medi-Cal income less than 138% of the Federal Poverty Level (FPL)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control group; A control group that receives a standard eligibility notice informing them of their eligibility for marketplace coverage.
Experimental: Enhanced Outreach; A treatment group that receives a standard eligibility notice informing them of their eligibility for marketplace coverage and an informational flyer describing what Covered California is, the availability of financial assistance, and information on benefit design and private insurance terminology, such as deductibles and copays.	Behavioral: Informational flyer; In addition to a standard eligibility notice informing participants of their eligibility for marketplace coverage, they receive an informational flyer describing what Covered California is, the availability of financial assistance, and information on benefit design and private insurance terminology, such as deductibles and copays
Experimental: Pre-Selected Plan; A treatment group that receives a modified eligibility notice that includes information on the pre-selected lowest-cost silver health insurance plan with a personalized quote for their net premium amount, as well as the informational flyer.	Behavioral: Modified eligibility notice with plan information; a modified eligibility notice that includes information on the pre-selected lowest-cost silver health insurance plan with a personalized quote for their net premium amount in addition to the informational flyer and instead of a standard eligibility notice

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Enrollment	a binary indicator for whether a consumer has at least one month of effectuated coverage a Covered California plan that started within the 90 days of their Special Enrollment Period (SEP) following loss of Medi-Cal coverage	within calendar year since the loss of Medicaid

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tenure	Tenure with Covered California (measured in months)	within 1-2 years after treatment assignment
Uninsured	A binary indicator for whether someone self-reported being uninsured while filing their taxes;	within 1-2 years from the treatment assignment
Consumer engagement	A binary indicator for consumer engagement including calls to service center, creation of and logins to user account, plan shopping on the website, agent delegation after eligibility determination;	within 90 days from the treatment assignment
Office visit	A binary indicator for whether someone had an office visit to the medical practitioner during 1-2 years since the intervention;	during 1-2 years since the treatment assignment
Prescription filled	A binary indicator for whether someone had a prescription drug fill during 1-2 years since the intervention;	during 1-2 years since the treatment assignment
Emergency room visit	A binary indicator for whether someone had an emergency room or department visit during 1-2 years since the intervention	during 1-2 years since the treatment assignment
Hospital admission	A binary indicator for whether someone had a hospital admission 1-2 years before and during 1-2 years since the intervention	1-2 years before and during 1-2 years after the treatment assignment
Out-of-pocket health care spending	Total out-of-pocket spending for the 1-2 years since the intervention	during 1-2 years since the treatment assignment

Collaborators and Investigators

• Sponsor: Covered California

Study record dates

Study Major Dates

• Study Start (Actual): March 25, 2024
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: November 18, 2024
• First Submitted That Met QC Criteria: November 25, 2024
• First Posted (Actual): November 29, 2024

Study Record Updates

• Last Update Posted (Actual): November 29, 2024
• Last Update Submitted That Met QC Criteria: November 25, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: CCA-MAPS-2024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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