Personalized Phone Calls, Emails Boosted ACA Enrollment Rate in CA

Personalized phone calls combined with email reminders were an effective outreach method for former Medicaid beneficiaries transitioning to Affordable Care Act (ACA) coverage, as the approach led to a 6.9 percentage point increase in California’s ACA enrollment rate, a JAMA Health Forum study found.

When the COVID-19 public health emergency expires, around 15 million Medicaid beneficiaries are projected to lose coverage due to redetermination processes and administrative churning.

Many of those who will lose Medicaid eligibility will be eligible for ACA marketplace subsidies, providing an alternative opportunity for coverage.

Researchers focused on 2,173 Californian households that recently lost Medicaid coverage and became eligible for subsidized marketplace coverage during a special enrollment period in 2017. They assigned the households to one of four groups to determine which outreach method impacted enrollment in Covered California, the state’s ACA marketplace.

The first group was the control and received no outreach except for the required eligibility determination notice provided based on households’ communication preferences. The second group received the required notification and email reminders about enrolling in marketplace coverage.

The third group received the required notice plus a personalized phone call offering enrollment assistance from a service center worker. The final group received the required information, email reminders, and a personalized phone call for enrollment assistance.

In November 2017, researchers used the Covered California administrative database to determine whether a household enrolled in marketplace coverage during the special enrollment period. They found that just 14.5 percent of the control group enrolled in Covered California, indicating that the required notice alone did not significantly improve enrollment.

Similarly, receiving the required notice plus email reminders did not increase the enrollment rate and led to a -0.5 percentage point decrease.

Personalized phone calls were more effective, increasing the enrollment rate by 4.4 percentage points or 30 percent. The email reminders combined with personalized phone calls had the most significant impact on enrollment, boosting the enrollment rate by 6.9 percentage points or 47 percent.

The results suggest resource-intensive strategies will be necessary to facilitate transitions from Medicaid to ACA marketplace coverage once the public health emergency ends.

A Health Affairs study from January 2022 also found that personalized phone calls helped improved ACA enrollment rates for Californians. Individuals who received a phone call had a higher enrollment rate by 1.3 percentage points or 10.8 percent compared to the control group that did not receive a call.

Behaviorally informed letters have also boosted ACA enrollment for people seeking healthcare coverage on HealthCare.gov. One study found that low-cost letters catering to different behavioral dynamics successfully increased marketplace enrollment by up to 1.6 percentage points.

Subsidized coverage on the ACA marketplace has contributed to growing enrollment in the individual health insurance marketplace. In the first quarter of 2022, around 16.9 million people enrolled in coverage on the individual health insurance marketplace, marking the highest rate since the first quarter of 2017.