Increasing Medicaid renewals with text message reminders
Additional messages and phone calls aimed at improving credibility of government communications did not affect the rate of health coverage renewals
A woman holding her baby and her phone
What is the agency priority?
Some families who are eligible for federal health coverage miss the deadline to renew their coverage. States often use paper mail to inform people of renewal deadlines, which can be costly and slow. Sending low-cost, automated text messages could ensure families get important information at the right time.
What did we evaluate?
Norfolk’s Department of Human Services manages Medicaid renewals for people in Norfolk, Virginia. Norfolk began sending text messages using a federal notification service (Notify.gov) to remind clients of upcoming renewal deadlines. We partnered with Norfolk to add two text messages and a phone call to their existing text outreach to make it more credible.
How did the evaluation work?
We ran a randomized evaluation from June to November 2024 among 7,468 Medicaid cases. All clients in the evaluation were sent three “business-as-usual” reminder messages. We randomly selected clients to receive the added text message and phone call outreach as follows:
- Before a cohort’s renewal window opened, cases were randomized into a credibility text group or a no credibility text group.
- In the middle of a cohort’s renewal window, cases that had not yet renewed were randomized to a phone call outreach group (who received a pre-call text message and a phone call) and a no phone call group (who received neither a pre-call text nor a phone call).
What did we learn?
Out of 7,468 cases in our sample, 6,872 (91%) renewed coverage during the evaluation. The additional text messages and phone calls did not significantly affect the number of renewals. For similar programs, excluding additional credibility texts and phone calls from their existing series of reminders would not result in decreased renewal rates. Although the added outreach did not increase renewal behavior in this evaluation, it is possible that this outreach increased trust in Norfolk’s communications, an outcome we did not measure. Future programs may wish to weigh the costs of additional outreach with the benefits of increasing trust, since additional outreach may not affect renewal rates.
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