In Partnership with The State of Hawaii Health & Human Services
In Hawaii, over 450,000 people—almost a third of the state’s population—were enrolled in Medicaid/CHIP in 2023, with 45% of all children qualifying for Medicaid assistance. However, the process of determining eligibility and renewing can be complicated, leading to missed benefits for those who qualify. To address this, the State of Hawaii aimed to create a streamlined and accessible outreach strategy using SMS and IVR (robocalls) to ensure more residents received the support they needed.
What CCL is Doing About It
CCL partnered with the State of Hawaii to design a multilingual SMS and IVR campaign in 17 languages, focused on simplifying the enrollment process. By providing clear guidance via text and robocalls, this outreach initiative aimed to help residents overcome barriers to enrollment. After rolling out this multilingual outreach campaign, the team analyzed its effectiveness by studying how well it reduced Medicaid terminations.
Program Goal
The primary goal of this initiative was to reduce procedural terminations, which happen when someone loses Medicaid for reasons unrelated to eligibility. (Example: not completing paperwork.)
The Power of Outreach
The study showed that sending text messages (SMS) and making phone calls (Interactive Voice Response or IVR) were much more effective than relying on mail-only communication. Here’s how the different methods stacked up:
- SMS Messages: Reduced the likelihood of losing Medicaid coverage by 23 percentage points compared to mail-only communication.
- Phone Calls (IVR): Reduced the likelihood of termination by 20 percentage points compared to mail-only.
The conclusion is clear: digital communication methods, like SMS and phone calls, are powerful tools for keeping people enrolled in Medicaid.
A Closer Look at Non-English Speakers
One of the most surprising findings was how outreach impacted individuals who listed a primary language other than English. Far from being less effective, texts and calls proved to be especially helpful for non-English speakers.
- Impact for Non-English Speakers:
- Phone calls reduced their termination rates by 17 percentage points.
- Text messages reduced their termination rates by 23 percentage points.
This means that non-English speakers are highly responsive to proactive outreach. However, it’s also important to note that their baseline termination rates (with mail-only communication) were already lower compared to English speakers. This suggests that multilingual or culturally tailored outreach strategies could further boost these positive outcomes.
Why Do Outreach Methods Matter?
The study highlighted key reasons why phone calls and SMS messages are more effective than mail-only communication:
- Accessibility:
- Phone calls and SMS messages reach people directly and immediately, while mail can often go unread or get lost, especially for individuals who move frequently.
- Customization:
- Texts and calls can be personalized and translated into preferred languages, making the messages more relevant and easier to understand.
- Proactivity:
- These methods prompt immediate action, reminding recipients to renew their coverage and providing simple next steps.
What About Income?
The study also found that outreach methods were most effective for people living in low- and middle-income areas. SMS messages, in particular, had the largest impact in these communities, reducing termination rates significantly. For higher-income areas, the effect of outreach methods was smaller but still noticeable.
Key Takeaways
- Texts and Calls Work: Phone calls and SMS messages significantly reduce Medicaid termination rates compared to mail-only communication.
- Non-English Speakers Benefit More: These groups saw some of the largest reductions in termination rates when proactive outreach was used.
- Target Low-Income Communities: SMS and phone calls are most impactful in areas where median incomes are lower.
- Language Data Matters: Understanding language preferences and improving data accuracy could enhance the effectiveness of outreach campaigns.
The Real-World Impact
The analysis estimates that sending SMS messages over five months prevented 3,874 people from losing their Medicaid coverage. If this approach were applied consistently over a year, it could save nearly 9,300 individuals from losing their health insurance due to procedural terminations. That’s a powerful reminder of how small changes in communication can create meaningful, large-scale results.
By using these insights, Medicaid programs can help ensure that more people retain their health coverage—a crucial step toward improving health outcomes and reducing disparities.