In September, states must start to notify Medicaid enrollees affected by new changes — including work requirements and new twice-yearly eligibility checks — that will begin in 2027.
These changes, introduced by the One Big Beautiful Bill Act of 2025 with a short implementation timetable, are expected to reduce Medicaid enrollment and potentially create confusion and chaos as beneficiaries try to understand whether and how new requirements affect them. States are required to notify people affected by the changing requirements using at least two outreach methods, but the exact methods are up to the state.
In what turned out to be good timing, we recently investigated what methods might be the most impactful, scalable, and low-cost. Our findings could help states determine cost-effective ways to connect Medicaid enrollees with assistance and prevent paperwork-related delays.
The process to confirm whether enrollees are still eligible, known as redetermination, has always been associated with red tape. Often, Medicaid enrollees lose coverage at the redetermination deadline not because they no longer qualify, but because of the difficulty in navigating renewal requirements.
This will only be exacerbated by the six-month redetermination rates and new work requirements introduced for many beneficiaries under the Trump administration’s tax and spending bill. As states roll out these new requirements, they will need strategies to ensure eligible people can maintain their Medicaid coverage.
Under the Trump tax bill, states are now required to notify people affected by these new requirements using not only written outreach (a physical letter or, if elected by the individual, an email) but also a second method of outreach. The second method could consist of posting on a website or something more costly (but potentially more effective) like a prerecorded phone call. Evidence is needed to inform states’ decisions about how to proceed.
A study we led evaluated exactly this problem: How can we better reach out to people facing Medicaid renewal deadlines and support them through the paperwork requirements of the renewal process? Our research examined how different outreach modalities by Covering Wisconsin — the state’s health insurance navigator program — affected Medicaid renewal and procedural disenrollment.
Working with Covering Wisconsin, we conducted outreach to people with upcoming Medicaid renewal deadlines and tested different methods, including postcards, text messages, and prerecorded calls. Although every participant received written outreach via a postcard or text message, some also received a prerecorded call offering navigator assistance.
We found that supplementing the state’s standard outreach with text messages and/or prerecorded phone calls could be cost-effective to connect eligible Medicaid enrollees with assistance and prevent procedural (paperwork) denials.
Our first key finding relates to written outreach methods. Everyone in the experiment was sent written outreach from Covering Wisconsin for ethical reasons, but some were randomly assigned a postcard and others a text message. We found no difference in Medicaid renewal rates between those two groups. This finding points to texts being a more cost-effective method, given that texts produced the same coverage impacts, but cost far less (9 cents versus 38 cents per contact).
Our second key finding relates to the impact of supplementing written outreach with a phone call. Supplementing written outreach with a prerecorded call offering navigator assistance increased Medicaid renewal by 1 percentage point and reduced procedural denials by 1 percentage point. Not all calls could be successfully placed, but for those who did receive the call, it increased their Medicaid renewal by 1.7 percentage points and decreased procedural denials by 1.8 percentage points.
Outreach and assistance can impact coverage outcomes for people who are Medicaid-eligible but struggle with the required processes. In a national survey of people who lost Medicaid coverage in 2023, 17.4% reported they believed they lost Medicaid because of inability to complete the renewal process, rather than voluntarily or due to ineligibility.
Based on the rates of Medicaid coverage loss in our sample, this would imply that 18% of potentially eligible people kept coverage because they were sent the supplemental prerecorded call. It’s not possible to identify potentially eligible people beforehand, but even when calls are sent to everyone, they may still be cost-effective: In our study, the technological costs of the call were just 15 cents per contact, which translates to roughly $15 per additional renewal, less than previous estimates of the value of Medicaid coverage.
The stakes of the renewal process are especially high for groups that might face greater barriers to renewal or greater health consequences from coverage loss. The effect of the prerecorded calls was greatest for Native American tribal members, children, and people with chronic conditions. Among tribal members in our study, for example, more than 1 in 3 lost coverage for procedural reasons, underscoring how unevenly administrative barriers fall across populations. Some Medicaid policies already account for this by exempting certain groups from the upcoming changes, including tribal members. More can still be done to better support other groups of beneficiaries who are particularly vulnerable to the changes introduced by the Trump tax and spending bill.
The study results also underscore the importance of expanding the range of outreach modalities to contact more people. Prior research shows that written outreach has tended to benefit healthier or higher-income enrollees, as they may face less friction when acting in response to the written outreach. If written outreach is the primary modality for reaching Medicaid beneficiaries, those who rely most on Medicaid will be missed more frequently.
Finally, our study also showed that successful outreach delivery is a key component that states need to consider. Outdated contact information can impede outreach efforts, and relying on only one type of outreach risks missing eligible beneficiaries. Increasing outreach modalities, each using different types of contact information, provides more opportunities to deliver critical information and contribute to more successful Medicaid renewals. We found that at least 1 in 5 phone numbers or addresses on file were no longer affiliated with the person of interest, meaning even well-designed outreach can fail before it starts. Creating new pathways for updating contact information can help ensure beneficiaries are informed about renewal processes and available help.
Incidentally, a provision of the One Big Beautiful Bill intended to reduce fraud will probably help with this issue. The bill establishes a process for managed care entities to share updated contact information with the Medicaid agency, which could help enable beneficiaries to receive important notices at their current address.
Increasing outreach modalities and leveraging navigators — which have existed in states since 2013 and are well-equipped to assist with member outreach, education, and renewal assistance — can meaningfully support beneficiaries during the renewal process. But to do this, navigators or other consumer-assistance groups must partner with the state to obtain contact information of Medicaid beneficiaries. As our study shows, navigators can streamline outreach tactics and serve as an educational touchpoint to beneficiaries about Medicaid and the redetermination process. Tech-enabled methods to expand outreach will become even more important given the recent 90% funding cut experienced by navigators.
With more frequent redeterminations set to roll out in the coming months, reducing avoidable procedural disenrollment should be a core strategy for helping eligible people stay covered. If Medicaid enrollees nationwide respond as those in Wisconsin, supplementing standard outreach with prerecorded calls could help hundreds of thousands more people renew their coverage.
Rebecca Myerson is an associate professor of health policy and management at Emory University’s Rollins School of Public Health. Allison Espeseth is Director of Covering Wisconsin, which is Wisconsin’s navigator program and a part of University of Wisconsin-Madison Division of Extension. Covering Wisconsin receives funding from Wisconsin Department of Health Services and Centers for Medicare and Medicaid Services, among other sources. Laura Dague is the James M. Griffin professor of health policy in the Department of Public Service and Administration in the Bush School of Government and Public Service at Texas A&M University. The project was funded by J-PAL. The authors would like to thank the Wisconsin Department of Health Services for the use of data in the analysis cited, but this agency does not certify the accuracy of the analyses presented.