Health BehaviorNCT05327712
Using Emails and Personalized Phone Calls to Increase Affordable Care Act Marketplace Enrollment Among Households Losing Medicaid
A study testing Email only, Phone only and Phone and email in people with Health Behavior, run by Office of Evaluation Sciences at 1 site in United States.
Trial 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. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Health Behavior
- What is being tested?
- Email only, Phone only and Phone and email
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 2,173 participants
- Where
- 1 siteUnited States
- Study dates
- 30 Aug 2017to 17 Nov 2017
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- Those who recently lost Medicaid eligibility and became eligible for subsidized Affordable Care Act coverage
Who cannot join
- Those who recently lost Medicaid eligibility and were found ineligible for subsidies.
Trial locations and contacts
1 site in 1 country.
About this study
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.
- Conditions
- Health Behavior
- Being tested
- Control group, Email only, Phone only, Phone and email
- Keywords
- Affordable Care Act, randomized controlled trial, Medicaid
- Medical subject headings
- Health Behavior
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Control groupBehavioural
Also called No outreach
No outreach during the intervention period beyond an initial eligibility notice.
Email onlyBehavioural
Email reminders in addition to an initial eligibility notice.
Phone onlyBehavioural
Phone call offering enrollment assistance in addition to an initial eligibility notice.
Phone and emailBehavioural
Phone call and email reminders in addition to an initial eligibility notice.
| Study group | Role | What they receive |
|---|---|---|
| Control | Experimental | The control group was assigned to receive no outreach beyond an initial eligibility determination notice Receives: Behavioral: Control group |
| Email-only | Experimental | An email-only group assigned to receive an initial eligibility determination plus email reminders about signing up for marketplace coverage Receives: Behavioral: Email only |
| Phone-only | Experimental | A phone-only group assigned to receive an initial eligibility determination plus a phone call offering enrollment assistance from a service center representative (SCR); Receives: Behavioral: Phone only |
| Phone and email | Experimental | 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. Receives: Behavioral: Phone and email |
What is being measured
The primary outcome is the main question the study is designed to answer.
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
Measured: Two months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Apr 2022
- Study start30 Aug 2017
- Primary completion30 Oct 2017
- Study completion17 Nov 2017
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Health BehaviorStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 2,173 participants (actual)
Sponsor and investigators
- Lead sponsor
- Office of Evaluation Sciences
- Sponsor type
- US federal agency
- Responsible party
- Principal investigator, Andrew Feher, Office of Evaluation Sciences
- Investigators
- Andrew Feher, PhD, Principal investigator, Covered California
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05327712
- Sponsor's protocol ID
- 042022
- Status last verified
- Jun 2022
- First submitted
- 7 Apr 2022
- Last updated
- 16 Jun 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: 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.
Publications
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.
PubMed 36239955
Study at a glance
From the registry record, last updated by the sponsor on 16 Jun 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Using Emails and Personalized Phone Calls to Increase Affordable Care Act Marketplace Enrollment Among Households Losing Medicaid
- ClinicalTrials.gov ID
- NCT05327712
- Acronym / sponsor ID
- 042022
- Conditions
- Health Behavior
- Keywords
- Affordable Care Act, randomized controlled trial, Medicaid
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 2,173 participants (actual)
- Lead sponsor
- Office of Evaluation SciencesUS federal agency
- Study start
- 30 Aug 2017 (actual)
- Primary completion
- 30 Oct 2017 (actual)
- Study completion
- 17 Nov 2017 (actual)
- First posted
- 14 Apr 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| Control | Experimental | Behavioral: Control groupThe control group was assigned to receive no outreach beyond an initial eligibility determination notice |
| Email-only | Experimental | Behavioral: Email onlyAn email-only group assigned to receive an initial eligibility determination plus email reminders about signing up for marketplace coverage |
| Phone-only | Experimental | Behavioral: Phone onlyA 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 | Experimental | Behavioral: Phone and emailA 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. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (1 listed)
- Those who recently lost Medicaid eligibility and became eligible for subsidized Affordable Care Act coverage
Key exclusion criteria (1 listed)
- Those who recently lost Medicaid eligibility and were found ineligible for subsidies.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Control groupAlso: No outreachNo outreach during the intervention period beyond an initial eligibility notice. | Behavioural | Control |
| Email onlyEmail reminders in addition to an initial eligibility notice. | Behavioural | Email-only |
| Phone onlyPhone call offering enrollment assistance in addition to an initial eligibility notice. | Behavioural | Phone-only |
| Phone and emailPhone call and email reminders in addition to an initial eligibility notice. | Behavioural | Phone and email |
Primary outcome
Percent of households enrolled in an ACA plan by the end of the October 2017
Time frame: Two months
Percent of households enrolled in an ACA plan during the intervention period
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 Jun 2022.
- Derived from this study: PubMed 36239955Ravel 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.
- Individual participant dataSharing planned: Yes. 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.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Andrew Feher, PhD principal investigator
Covered California
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Email only, Phone only and Phone and email in people with Health Behavior, run by Office of Evaluation Sciences at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 16 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Percent of households enrolled in an ACA plan by the end of the October 2017 (time frame: Two months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05327712, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Jun 2022.