Smooth Journey: Facilitating Transitions from Medicaid to Marketplace Plans Using Phone Outreach

Abstract Importance Households that are no longer eligible for Medicaid can obtain health coverage through the individual marketplace, yet many do not. Informational and administrative barriers, coupled with a complex insurance choice environment in marketplaces, may lead to gaps in health coverage. Objective To assess the effect of phone outreach on marketplace enrollment among households who lost Medicaid coverage and were automatically enrolled in a subsidized marketplace plan. Methods We conducted a randomized trial of phone outreach among 39,456 households recently discontinued from Medicaid and eligible for subsidized coverage in the marketplace in California. Results Phone outreach increased take-up in the treatment group to 17.4% (95%CI: 16.6-18.1%) compared to 12.5% (95% CI: 12-12.9%) in the control group that did not receive a call (a relative increase of 39.2%). Outbound call outreach was especially effective among households with Spanish as preferred spoken language, whose take-up increased by 66.7% compared to the control group. Conclusions The results of this randomized controlled trial show that even in a setting with automatic enrollment into low or no-cost plans and minimal administrative and cost barriers, direct phone outreach is an effective mechanism for helping consumers transition from Medicaid to Marketplace coverage.