Navigator Outreach for Medicaid Enrollment

Overseen By Rebecca Myerson, MPH, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

Disqualifiers: Non-English, Non-Spanish, No cell phone

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines how different types of outreach from navigators affect Medicaid enrollment in Wisconsin. Navigators assist individuals in renewing Medicaid coverage. The trial will test various outreach methods, such as text messages, phone calls, and postcards, to determine which is most effective. Medicaid recipients in Wisconsin who need to renew their coverage may find this trial suitable. Participants should speak English or Spanish and have a cell phone number. As an unphased trial, this study offers a unique opportunity to improve Medicaid renewal processes and potentially benefit the community.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems unlikely, as the trial focuses on Medicaid enrollment, not medical treatment.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that navigator outreach is safe for Medicaid enrollment?

Research has shown that receiving help from navigators is generally safe for participants. Although specific studies on safety are lacking, as this involves communication rather than medical procedures, using navigators for Medicaid enrollment has not been known to cause harm. For instance, in 2019, navigators assisted about 205,000 people without any reported safety issues, suggesting that the process is well-tolerated. Participants can expect to receive messages or calls to assist with Medicaid renewal, a common practice. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative outreach methods to help people enroll in Medicaid. Unlike traditional enrollment processes, these approaches utilize technology like text messages and chatbots to connect with navigators, making the process more accessible and engaging. Some methods also include reminder messages and outbound calls, providing multiple touchpoints to ensure participants are well-informed and supported. This trial aims to find out which techniques are most effective in increasing Medicaid enrollment, potentially transforming how similar programs are conducted in the future.

What evidence suggests that navigator outreach is effective for Medicaid enrollment?

Research has shown that navigators can significantly ease the process of renewing Medicaid coverage. This trial will evaluate various outreach methods, such as text messages and postcards, to connect participants with navigators. Studies have found that pre-recorded calls can prevent coverage denial due to paperwork issues and increase renewal rates by about 1%. The navigator program educates people about Medicaid and guides them through the renewal process. By offering one-on-one assistance, navigators simplify the process, helping people understand their options and complete the necessary steps to maintain their coverage. ^{5 6 7 8 9}

Who Is on the Research Team?

Rebecca Myerson, MPH, PhD

Principal Investigator

UW-Madison School of Medicine and Public Health

Are You a Good Fit for This Trial?

This trial is for individuals in Wisconsin who are enrolled in fee-for-service Medicaid and need to renew their coverage. Participants must be on the lists provided by Wisconsin DHS to Covering Wisconsin, understand English or Spanish, and have a cellular phone number.

Inclusion Criteria

Included on the lists Wisconsin DHS provides to Covering Wisconsin of fee-for-service Medicaid beneficiaries who need to renew their Medicaid coverage

Exclusion Criteria

Lack a cellular phone number

I prefer communicating in a language other than English or Spanish.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Outreach Intervention

Participants receive various forms of outreach to assist with Medicaid renewal, including text messages, postcards, and outbound calls.

up to 1 year

Follow-up

Participants are monitored for the effectiveness of outreach strategies on Medicaid enrollment and renewal.

up to 1 year

What Are the Treatments Tested in This Trial?

Interventions

• Outreach From Navigators

Trial Overview The study is testing how different types of outreach from navigators affect Medicaid enrollment rates. Navigators help with one-on-one assistance during the renewal process. People will be randomly assigned to receive various forms of this outreach.

How Is the Trial Designed?

Group I: Outreach via Text Message Encouraging a Call to a Hotline for Assistance + a Reminder Message Experimental Treatment 1 Intervention

Outreach via text message encouraging a call to a hotline for assistance plus a similar reminder message two weeks later (15% of sample)

Group II: Outreach via Text Message Encouraging Text Reply To Connect with Navigators+ a Reminder Message Experimental Treatment 1 Intervention

Outreach via text message encouraging a text reply to connect with navigators via chatbot plus a similar reminder message two weeks later (15% of sample)

Group III: Outreach via Text Message Encouraging Text Reply To Connect with Navigators + Outbound Call Experimental Treatment 1 Intervention

Outreach via text message encouraging a text reply to connect with navigators via chatbot, plus an outbound phone call from navigators (7.5% of sample)

Group IV: Outreach via Text Message Encouraging Text Reply To Connect with Navigators Experimental Treatment 1 Intervention

Outreach via text message encouraging a text reply to connect with navigators via chatbot (15% of sample)

Group V: Outreach via Text Message Encouraging Reply To Connect with Navigators + Reminder Message Experimental Treatment 1 Intervention

Outreach via text message encouraging a text reply to connect with navigators via chatbot plus a similar reminder message two weeks later + outbound call (7.5% of sample)

Group VI: Outreach via Text Message Encouraging Call to Hotline + Outbound Call Experimental Treatment 1 Intervention

Outreach via text message encouraging a call to a hotline for assistance, plus outbound phone call from navigators (7.5% of sample)

Group VII: Outreach via Text Message Encouraging Call to Hotline Experimental Treatment 1 Intervention

Outreach via text message encouraging a call to a hotline for assistance (15% of sample)

Group VIII: Outreach via Postcard + Outbound Call Experimental Treatment 1 Intervention

Outreach via postcard, plus placed an outbound phone call from navigators (20% of sample)

Group IX: Outreach via Postcard Experimental Treatment 1 Intervention

40 percent of the sample

Group X: Outreach Text Message Encouraging Call a Hotline for Assistance + Reminder Message Experimental Treatment 1 Intervention

Outreach via text message encouraging a call to a hotline for assistance plus a similar reminder message two weeks later + outbound call (7.5% of sample)

Outreach From Navigators is already approved in United States for the following indications:

Approved in United States as Navigator Outreach for:

• Medicaid Enrollment Assistance
• Health Insurance Navigation

Who Is Running the Clinical Trial?

University of Wisconsin, Madison

Lead Sponsor

Trials

1,249

Recruited

3,255,000+

Covering Wisconsin

Collaborator

Trials

3

Recruited

649,000+

Published Research Related to This Trial

The creation of a student-led Medicaid Enrollment Team at the HOPES free clinic aimed to help citizens overcome barriers to enrolling in Medicaid after its expansion in Virginia.

The paper outlines effective steps taken by this program that can serve as a model for future Medicaid enrollment efforts, emphasizing the importance of comprehensive assistance in improving access to healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing a Sustainable Model for Medicaid Enrollment at the HOPES Free Clinic. Taylor-Fishwick, JS., Patel, P., Van de Graaf, M., et al.[2021]

In a study of 696 patients across 7 intensive care units, 15.5% experienced adverse drug events (ADEs), with a significant portion (70%) of these being nonpreventable adverse drug reactions (ADRs).

The research highlighted that most preventable ADEs stemmed from medication errors during the prescribing stage (71.1%), indicating a critical need for improved pharmacovigilance and error reporting practices to enhance drug safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Incidence of adverse drug events and medication errors in intensive care units: a prospective multicenter study. Benkirane, RR., Abouqal, R., Haimeur, CC., et al.[2022]

The implementation of the Patient Navigator Program for hospitalized heart failure patients led to a significant reduction in the 30-day all-cause readmission rate, dropping from 25.6% at the medical center to 17.6% with the program.

Patients who received targeted interventions from the Navigator Team, such as education and follow-up, experienced even lower readmission rates of 10.3% and 6.1%, respectively, highlighting the effectiveness of personalized care in improving patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of a Patient Navigator Program to Reduce 30-day Heart Failure Readmission Rate. Di Palo, KE., Patel, K., Assafin, M., et al.[2018]

Enrollment navigators and Medicaid workers were crucial for the initial success of the Affordable Care Act (ACA), but significant funding cuts (41% for navigators and 90% for outreach) threaten ongoing enrollment efforts.

Focus group discussions with 101 enrollment workers in California revealed a strong need for better communication and collaboration among workers and policymakers to address barriers and improve enrollment strategies, especially for vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Medicaid Access in Times of Health Policy Change: Solutions from Focus Groups with Frontline Enrollment Workers. Raymond-Flesch, M., Lucia, L., Jacobs, K., et al.[2019]

A pharmacist-led program effectively managed adverse events in 123 patients with EGFR mutation-positive non-small cell lung cancer receiving afatinib, highlighting the importance of patient education and proactive monitoring in a community oncology setting.

Common adverse events included diarrhea (85%) and rash/skin reactions (58%), with 13% of patients discontinuing treatment due to these side effects; however, those who continued treatment often had dose reductions, indicating a strategy to maintain therapy despite adverse effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting. Khrystolubova, N., Shieh, M., Patel, AJ., et al.[2020]

In 2013-2014, there were an estimated 4.0 emergency department visits per 1000 individuals annually for adverse drug events in the U.S., with 27.3% of these visits resulting in hospitalization, highlighting the significant impact of medication-related issues on patient safety.

Anticoagulants, antibiotics, and diabetes agents accounted for nearly half (46.9%) of these adverse drug events, with older adults (aged 65 and older) experiencing the highest hospitalization rates, indicating a need for careful medication management in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. Shehab, N., Lovegrove, MC., Geller, AI., et al.[2022]

The Affordable Care Act (ACA) significantly increased access to health insurance, particularly through Medicaid expansion and health insurance marketplaces, with various outreach strategies employed by states during the first enrollment season.

Local health departments (LHDs) are underutilized resources in ACA outreach and enrollment efforts, and case studies, including one from West Virginia, highlight innovative models and best practices for LHD involvement to enhance community engagement and enrollment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on West Virginia. Elligers, JJ., Bharmal, N., Martin, LT., et al.[2020]

The implementation of a patient navigator program at a public hospital significantly improved adherence to breast cancer quality care indicators from 69% to 86% among 100 newly diagnosed patients (Stages I to III).

The program particularly enhanced the use of surveillance mammography, increasing adherence from 52% to 76%, demonstrating that patient navigators can effectively address barriers to care in uninsured populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving breast cancer quality of care with the use of patient navigators. Chen, F., Mercado, C., Yermilov, I., et al.[2010]

The use of patient navigators (PNs) significantly reduced healthcare costs for high-risk patients aged 60 and older, with total costs dropping from $7,640 to $5,676 within 180 days post-discharge.

While the PN intervention showed cost savings for older patients, it did not significantly impact costs for those under 60, suggesting that PNs may be particularly beneficial for older adults in transitional care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-Term Impact of a Postdischarge Community Health Worker Intervention on Health Care Costs in a Safety-Net System. Galbraith, AA., Meyers, DJ., Ross-Degnan, D., et al.[2019]

A successful patient navigation program for American Indian populations in the Northern and Southern Plains increased community knowledge about cancer and improved cancer screening behaviors through 24-hour workshops.

Collaboration with trusted Native Patient Navigators helped bridge the gap between patients and healthcare providers, enhancing adherence to care recommendations and ultimately improving quality of life and survival rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Navigation as an intervention to eliminate disparities in American Indian communities. Krebs, LU., Burhansstipanov, L., Watanabe-Galloway, S., et al.[2021]

Navigators in the federal Insurance Navigator Program play a crucial role in promoting health equity by providing essential services and support to underserved communities, going beyond their basic responsibilities.

The study highlights that navigators develop their equity skills through on-the-job experience, but face significant challenges due to financial instabilities, which hinder their ability to effectively assist those in need.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lack of Consistent Investment in Federal Insurance Navigator Program Undermines Navigators' Equity Work in Vulnerable Communities. van Eijk, MS., Kett, PM., Prueher, L., et al.[2023]

Iowa's Medicaid expansion included a personal responsibility component, but early evaluations showed low compliance and awareness among enrollees, highlighting a gap in understanding the program.

Interviews with outreach staff at Federally Qualified Health Centers (FQHCs) revealed that these centers employ various strategies to help individuals enroll in Medicaid and navigate their health insurance, indicating a crucial support role as Medicaid programs become more complex.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Communicating a Complicated Medicaid Waiver Program to Enrollees in Iowa: How Federally Qualified Health Centers Support Medicaid Members. Askelson, NM., Brady, PJ., Wright, B., et al.[2021]

Patient navigation programs have shown a low refusal rate (4%-6%) for clinical trial participation among medically underserved populations, indicating potential effectiveness in reducing barriers to enrollment.

However, there is a need for more research to evaluate the overall efficacy of these programs in increasing clinical trial enrollment, as few studies have reported on this outcome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

State-of-the-science of patient navigation as a strategy for enhancing minority clinical trial accrual. Ghebre, RG., Jones, LA., Wenzel, JA., et al.[2023]

Adverse drug events (ADEs) contribute to 1.7-11% of hospital admissions and occur in 1-44% of hospitalized patients, yet less than 10% of these events are reported to national agencies, highlighting a significant gap in safety reporting.

While 75% of nursing schools promote awareness of ADE reporting, only about half provide training on how and what to report, indicating a need for improved education and support for advanced practice nurses to enhance public safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse drug event reporting and advanced-nursing practice. Meints, AS.[2019]

A study of 377 Texas pharmacists revealed that 67.9% had never reported adverse drug events (ADEs) to the FDA, indicating a significant gap in reporting practices.

Most pharmacists (65.7%) felt they lacked adequate knowledge about ADE reporting, highlighting the need for improved education and training on how to report ADEs effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Texas pharmacists' knowledge of reporting serious adverse drug events to the Food and Drug Administration. Gavaza, P., Brown, CM., Lawson, KA., et al.[2015]

Citations

1. povertyactionlab.org povertyactionlab.org/evaluation/impact-outreach-and-assistance-navigators-medicaid-renewals-united-states

The Impact of Outreach and Assistance from Navigators on ... Outreach using pre-recorded calls prevented denials due to procedural reasons and increased Medicaid renewal rates by 1.0 percentage point across the full study ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10805367/

INFORMATION GAPS AND HEALTH INSURANCE ... As noted above, two key goals of the navigator program were to inform consumers about affordability programs, including Medicaid, and to facilitate health ...

3. cms.gov cms.gov/marketplace/resources/data/2016-2024_Navigator_Funding_and_Enrollment_Data.xlsx

2024 Navigator Funding and Enrollment Data. All 1:1 assistance provided to consumers by Navigators, excluding QHP enrollments and Medicaid/CHIP enrollments or referrals. Assistance in this category ...

4. kff.org kff.org/medicaid/survey-of-health-insurance-marketplace-assister-programs/

Survey of Health Insurance Marketplace Assister Programs Navigator refers to Assister Programs that contract directly with the U.S. Centers for Medicare & Medicaid Services (CMS) to provide free ...

5. med.wisc.edu med.wisc.edu/news/aca-navigator-program-boosted-insurance-enrollment/

Affordable Care Act navigator program boosted insurance ... “Our research showed that the navigator program impacted coverage among the same underserved communities that many navigator programs said, in ...

6. cms.gov cms.gov/newsroom/press-releases/cms-announcement-federal-navigator-program-funding

CMS Announcement on Federal Navigator Program Funding Data show that for the 2019 plan year, Navigators provided post-enrollment assistance to approximately 205,000 consumers. Despite markedly ...

7. health.ny.gov health.ny.gov/health_care/medicaid/data_rpts/

Medicaid Data and Reports New York State Medicaid Enrollment Data. Medicaid enrollment trends. Monthly view of NYS Medicaid enrollment by residential county.

8. medicaid.gov medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights

June 2025 Medicaid & CHIP Enrollment Data Highlights These data reflect a range of indicators related to key Medicaid and CHIP application, eligibility, and enrollment processes. View the complete dataset on Data.

9. kff.org kff.org/medicaid/2022-survey-of-aca-marketplace-assister-programs-and-brokers/

2022 Survey of ACA Marketplace Assister Programs and ... About half of Assister Programs (53%) said they have good working relationships with their state Medicaid agency and nearly 6 in 10 said they ...