Phone Calls for Uninsured

Overseen By Rebecca Myerson, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

Disqualifiers: Language preference, No working phone

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

Compensation: Varies

Number of Visits: Unknown

425000 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests different phone call methods to help people regain Medicaid coverage after losing it due to procedural issues. It compares the effectiveness of live calls from a Navigator with pre-recorded calls. The goal is to determine which method better encourages Medicaid re-enrollment. Individuals who lost Medicaid coverage between June 2024 and November 2025 and speak English, Spanish, or Hmong might find this trial of interest. As an unphased trial, it offers a unique opportunity to contribute to improving Medicaid re-enrollment processes.

Will I have to stop taking my current medications?

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

What prior data suggests that these outreach methods are safe?

Research has shown that phone calls, whether live or pre-recorded, are safe and well-received methods for reaching out to people. One study found that personalized phone calls, especially live ones, effectively encouraged people to take actions like signing up for programs such as Medicaid, without causing harm or discomfort. Similarly, pre-recorded calls have successfully shared information, with no reports of negative effects. These methods aim to improve access to healthcare, and no evidence of safety issues exists. Therefore, participating in a trial using phone call outreach is considered safe. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these outreach methods for uninsured individuals because they explore new ways to enhance healthcare access. Unlike traditional in-person consultations, these approaches involve outbound phone calls, either live or pre-recorded, to connect with patients who might not otherwise seek care. The live outreach involves a personalized call from a Navigator, offering direct assistance and support, while the pre-recorded calls provide essential information and a hotline number for further help. These strategies aim to bridge gaps in healthcare access by using convenient communication methods, potentially reaching more people and encouraging them to engage with healthcare services.

What evidence suggests that this trial's outreach methods could be effective for improving Medicaid access?

Research has shown that live phone calls from Navigators can significantly boost Medicaid enrollment. One study found that personalized phone calls led to a 2.7% increase in health insurance sign-ups. Another study discovered that up to 18% of potentially eligible individuals retained their coverage due to these calls. In this trial, participants in the "Live Outreach" arm will receive personalized calls. Meanwhile, those in the "Pre-recorded Outreach" arm will receive pre-recorded calls, which can assist some people in enrolling but are generally less effective than live calls. Pre-recorded messages mainly provide information on obtaining further assistance but lack the direct engagement of live calls. Overall, live calls more effectively encourage Medicaid enrollment. ^{1 2 6 7 8}

Who Is on the Research Team?

Rebecca Myerson, PhD

Principal Investigator

University of Wisconsin, Madison

Are You a Good Fit for This Trial?

This trial is for individuals who were eligible for Medicaid but lost their coverage between June 2024 and November 2025 due to procedural reasons. There are no specific exclusion criteria mentioned.

Inclusion Criteria

I am eligible for Medicaid.

I lost my Medicaid coverage between June 2024 and November 2025.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive either a live outbound call or a pre-recorded call from a Navigator to improve Medicaid enrollment

3 months

Follow-up

Participants are monitored for Medicaid enrollment success and coverage gaps

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Outbound phone call

Trial Overview

The study is testing the effectiveness of live phone calls from a Navigator in helping people re-enroll in Medicaid after losing it. It compares the success rate of these calls with pre-recorded messages.

How Is the Trial Designed?

Group I: Pre-recorded Outreach Experimental Treatment 1 Intervention

People in this cohort will receive a pre-recorded outbound call providing a hotline number

Group II: Live Outreach Experimental Treatment 1 Intervention

People in this cohort will receive a live outbound call from a Navigator

Group III: No outreach Active Control 1 Intervention

People in this cohort will not receive outreach of any kind

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+

Arnold Ventures

Collaborator

Trials

3

Recruited

2,100+

Published Research Related to This Trial

The Project Access Dallas (PAD) program significantly reduced emergency department (ED) visits among uninsured patients, with enrollees averaging 0.93 visits compared to 1.44 for controls, indicating improved access to primary care.

Participants in the PAD program also experienced lower hospital costs, with direct costs reduced by approximately 60% and indirect costs by 50%, demonstrating the program's effectiveness in reducing healthcare expenses for uninsured individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of a community-based partnership, Project Access Dallas (PAD), on emergency department utilization and costs among the uninsured. DeHaven, M., Kitzman-Ulrich, H., Gimpel, N., et al.[2019]

Project Access-New Haven (PA-NH) has successfully improved access to specialty care for uninsured adults, providing timely medical care with an average wait time of just 17 days for appointments.

The program has engaged over 200 volunteer specialty physicians and has already assisted 78 patients, demonstrating a coordinated-care model that encourages physician participation in caring for vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Project Access-New Haven: improving access to specialty care for patients without insurance. Spatz, ES., Phipps, MS., Lagarde, S., et al.[2013]

Nonprofit hospitals significantly reduce the amount of outpatient care provided to uninsured patients when Medicare payment rates are cut, indicating a direct link between payment rates and care availability.

In contrast, for-profit hospitals increase the share of outpatient care for uninsured patients without changing the total number of uninsured discharges, highlighting differing responses to Medicare payment cuts based on hospital ownership.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medicare Payment and Hospital Provision of Outpatient Care to the Uninsured. He, D., Mellor, JM.[2018]

A study of 710 callers to a nurse advice line found that 70% complied with the recommendations given, leading to a significant change in their healthcare actions, with many opting for lower intensity care.

This shift in patient behavior resulted in a potential annual cost savings of $322,249 for the safety net healthcare system, highlighting the effectiveness of telephone triage in managing care for uninsured and managed care populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating patient compliance with nurse advice line recommendations and the impact on healthcare costs. Bogdan, GM., Green, JL., Swanson, D., et al.[2019]

In a study of 26 uninsured patients over a 10-month period, a free clinic visit led to significant improvements in health status and provided $6,500 worth of care.

The free clinic resulted in a substantial cost savings of $33,145 by reducing the need for emergency department visits and hospitalizations, highlighting its effectiveness in managing healthcare for low-income individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes and cost savings of free clinic care. Crump, WJ., Fricker, RS., Crump, AM., et al.[2019]

Emergency physicians in Michigan face significant financial losses due to nonreimbursed care for uninsured patients, estimated at approximately $31.7 million per year based on Medicare fee schedules.

The study analyzed data from 29 hospitals covering over 1.1 million emergency department visits, revealing that uninsured patients accounted for about 11.1% of these visits, with a substantial gap between expected and actual reimbursements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financial impact on emergency physicians for nonreimbursed care for the uninsured. Irvin, CB., Fox, JM., Pothoven, K.[2019]

A study conducted over five years with 33,602 respondents found that despite the introduction of new unscheduled care services like NHS Direct and walk-in centers, the use of traditional providers, particularly general practitioners (GPs), remained stable.

The research indicated an increase in the use of telephone help lines, but most people still preferred to seek help from GPs, family, and pharmacists, highlighting the continued reliance on traditional healthcare sources for unscheduled care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring the effect of changes to service provision on the use of unscheduled care in England: population surveys. O'Cathain, A., Knowles, E., Munro, J., et al.[2019]

Despite Medicaid expansion leading to a decrease in the uninsured rate, access to outpatient orthopedic care for Medicaid patients in Louisiana remains very limited, with only 18.3% of surveyed practices offering appointments.

Out of 93 orthopedic practices contacted, only 13.3% of orthopedic surgeons were willing to accept new Medicaid patients, and this number dropped to 7.1% when excluding those at safety-net facilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Access to Orthopedic Care post Medicaid Expansion Through the Affordable Care Act. Marrero, CE., Igbokwe, LI., Leonardi, C.[2019]

Uninsured patients were significantly more likely to undergo emergent surgeries for biliary, colorectal, and hernia operations, with odds ratios indicating a higher propensity for urgent care needs (ORs ranging from 2.43 to 3.95).

Despite the higher rates of emergent surgeries among the uninsured, patients with government insurance experienced more postoperative complications, highlighting a disparity in outcomes that suggests a need for policy changes to improve healthcare access and quality for all.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Worse outcomes among uninsured general surgery patients: does the need for an emergency operation explain these disparities? Schwartz, DA., Hui, X., Schneider, EB., et al.[2022]

In the Nordic countries, out-of-hours medical services vary significantly, with Denmark being the only country offering these services completely free of charge.

In Denmark and most of Norway, patients must first contact a physician-operated call-in service before receiving care, while house calls are infrequent in Sweden and Finland but represent about 20% of out-of-hours care in Norway and Denmark.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[On-duty medical service regulation in Norway, Sweden, Finland and Denmark]. Christensen, MB., Olesen, F.[2006]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8844881/

Personalized Telephone Outreach Increased Health ...

We stratified the data to test the impact of an outbound phone call on enrollment by application source (referral from the Medicaid eligibility system ...

2.

healthaffairs.org

healthaffairs.org/doi/pdf/10.1377/hlthaff.2021.01000

Up For Hard-To-Reach Populations, But Challenges Remain

This study evaluates the impacts of one such intervention—personalized, live outbound tele- phone calls from service center representatives— on ...

3.

researchgate.net

researchgate.net/publication/357599775_Personalized_Telephone_Outreach_Increased_Health_Insurance_Take-Up_For_Hard-To-Reach_Populations_But_Challenges_Remain_Study_examines_personalized_telephone_outreach_to_increase_take_up_of_ACA_Marketp

(PDF) Personalized Telephone Outreach Increased Health ...

Among subgroups, receiving a call significantly increased enrollment among consumers with income below 200 percent of the federal poverty level (4.0 percentage ...

4.

nber.org

nber.org/system/files/working_papers/w34191/w34191.pdf

NBER WORKING PAPER SERIES NAVIGATING MEDICAID

Applied to our sample, this would imply that 18% of potentially eligible people kept their coverage due to being sent our phone call outreach.

5.

healthaffairs.org

healthaffairs.org/doi/abs/10.1377/hlthaff.2021.01000

Personalized Telephone Outreach Increased ...

Personalized Telephone Outreach Increased Health Insurance Take-Up For Hard ... Receiving a call increased enrollment by 2.7 percentage points (22.5 percent) ...

6.

aspe.hhs.gov

aspe.hhs.gov/sites/default/files/documents/9a943f1b8f8d3872fc3d82b02d0df466/coverage-access-2021-2024.pdf

Healthcare Insurance Coverage, Affordability of ...

The uninsured rate was 7.6 percent in the second quarter of 2024. • Over 300 million Americans now have health insurance coverage. This includes ...

7.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/24026301/

Access to care outcomes: a telephone interview study ...

A telephone interview survey evaluated health care utilization, satisfaction, and health status outcomes and compared recent enrollees to individuals in the ...

8.

sciencedirect.com

sciencedirect.com/science/article/pii/S1542356520310636

Randomized Controlled Trial of Advance Notification ...

In a randomized trial, advance notification live phone calls outperformed text messages in prompting health center patients who had not previously completed a ...