Medicaid is a federal program that provides free or cheap health insurance for more than 70 million Americans who are either low-income or have disabilities. The program is massive and costs hundreds of billions of dollars each year.
According to one finding, around 20% of people who receive Medicaid lose their coverage during the renewal process. This means that every year, more than 9 million people who were previously eligible lose their benefits because they don’t fill out the right paperwork.
How to address this issue of bureaucracy and red tape is a question that researchers like Laura Dague have been wrestling with.
She’s a professor of health policy at the Bush School at Texas A&M University and coauthor of a new working paper on this subject. She joined the Standard to discuss their findings.
This transcript has been lightly edited for clarity.
Texas Standard: You and a team of researchers designed an experiment to try and address this issue in which people lose coverage due to red tape. Could you explain how it worked?
Laura Dague: Our study was set up to look at whether sending folks outreach offering free help from trained health insurance navigators could work to help eligible people enrolled in their coverage when they tried to renew.
And so we worked with a trusted community health insurance navigator group in Wisconsin called Covering Wisconsin and sent pre-recorded phone calls to more than 55,000 households offering help from our navigators to help renew their Medicaid.
So, someone already on Medicaid would receive a telephone call from your group. How effective was that in preventing these coverage lapses?
Yeah, this was a simple 30-second message saying who we were, your coverage is up for renewal, here’s a number to call or a website to visit for free help.
And our navigators were available to everyone, regardless of the study, but this small nudge intervention doubled the rate that people called them. And it prevented about 1 in 100 people from losing their coverage.
It sounds to me like it’s pretty effective. Was that what you were expecting to see?
So outreach or nudge interventions can sometimes have small effects. Among those who we think were eligible, we helped around 1 in 5 of them stay enrolled. Because, of course, not everyone we might be calling, some people might have had a change in their circumstances that make them not eligible.
But in fact, with this study, once we figured out how well it was working, we actually went ahead and sent those calls to everyone.
I was thinking, as you were describing the methodology here, where you had this pre-recorded message, a lot of people nowadays are really cautious when they get a call from a number they don’t know – and in fact, Medicare and Medicaid scams are incredibly common. What impact do you think that might have had on your findings?
Yeah, it’s right to be skeptical of robocalls, definitely. I think that this worked because we were very transparent that we were working in partnership with the state health agency, and we gave folks multiple ways to get help on their own timeline, look us up.
A big challenge was actually reaching people, because we think that around 40% of the phone numbers might’ve been out of date, which shows how much people move and change numbers when you’re trying to reach folks like this.
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Well, you heard my enthusiastic reaction. I’m curious about the sort of reaction you’ve been receiving from others, peers, people within your group of study. If I heard you correctly, we’re talking about a 1 to 1.5% increase in re-enrollments? Is that about right?
Yeah, that’s about right. So it’s helpful, I think, to just put in scale a little bit. Listeners might know that recently here in Texas, around 1.8 million people lost their Medicaid coverage after some temporary policies ended in 2023.
And so a lot more people than usual had been enrolled and had to try to renew, all around the U.S. There were worries that the short time folks had to get everybody processed with their paperwork might mean some people would lose coverage who shouldn’t.
One of the things that we were able to look at as kind of the bottom line is that there are some folks out there losing their health coverage at renewal, not because they don’t qualify, but just because they’re struggling with paperwork and renewal steps.
I guess that gets to the heart and soul of this, though. Why do so many people struggle with the paperwork issue?
Is it that there’s too much of it, that it’s too confusing, that they don’t know where to go to get the material that they need? What seem to be the obstacles?
Yeah. So I think it’s important to say that we have Medicaid renewal processes for two big reasons that are really important. So first is just that people’s circumstances change over time: They get new jobs, they move states. So we do have to check periodically to make sure they still qualify.
And second, it can be a way to manage the program costs and make sure that our taxpayer dollars go to people who really need help. So there are important reasons to do it well carefully.
There’s this idea, in economics, making people jump through hoops can be sometimes a good thing. If you really need insurance, you’ll do the paperwork is sort of the idea, but if you don’t, you won’t.
But of course, the problem then is that if we make those rules so hard to follow that we’re accidentally hurting people that we need to be helping. We wouldn’t wanna be asking people to prove their eligibility like weekly or monthly or something; that’d be a big hassle.
So part of what our study shows is, yes, that does happen sometimes that we make it a little too hard. People are losing coverage who are eligible. And we think that it actually helped with completing the form since when people called in to talk to the navigators, they were more successful.
