Driving Medicaid Renewals via Mobile App

SEPTEMBER 25, 2023

In an era of unprecedented human services challenges, Medicaid “unwinding” is the latest “all hands on deck” moment facing short-staffed state agencies. As of September 6, 2023, at least 5.7 million Medicaid beneficiaries have been disenrolled ever since a federal rule that protected coverage during the pandemic expired in March.

According to KFF, which has been tracking the re- and disenrollment, red tape is the cause behind 73 percent of disenrollments. In other words, 4.2 million Americans have lost health coverage because of paperwork issues, outdated contact information, and other administrative obstacles. 

For Propel, the potential impact on our users was immediately clear. Over 5 million households nationwide use the Providers app each month to manage government benefits, conduct banking, and save and earn money. Roughly 80 percent of these users were enrolled in Medicaid in 2022. Providers serves key populations that are disproportionately affected by the loss of Medicaid coverage, including 94 percent of users earning less than $50,000 a year, 52 percent of users who identify as people of color, and 500,000 users who prefer to access the app in Spanish.

As unwinding of the continuous enrollment provision began in early 2023, Propel developed and launched a multi-phase outreach campaign through the app that boosted information posted on state agency websites. The campaign has provided an additional “nudge” to increase awareness and to urge Providers users to take swift action. Over the past 6 months, Propel has reached more than 2.2 million Medicaid recipients through the app, supporting them in the process of updating their contact information with their state agency. 

The following case study explores key components of Propel’s campaign and captures learnings that can be applied to maximize the efficacy of ongoing Medicaid renewals outreach and other critical communications to recipients of public benefits.

Designing an effective outreach campaign 

Highly engaged, our users visit the Providers app an average of 15 times or more each month and rely on the platform for more than just balance checking. A section of the app called the “Benefits Hub” contains information about benefit changes in every state and US territory. Our users have come to see Providers as a trusted source of timely information about benefits where they can verify what they have heard on social media, the news, or by word of mouth. 

Transmitting accurate, actionable information about changes in public benefits has been essential in recent years. The national pandemic response led to substantial expansions of the safety net, and ensuing reductions of benefit programs have placed a heavy compliance burden on households and state agencies. With our unique ability to meet users where they are, we had a responsibility to design a personalized and actionable outreach campaign that would cut through the noise.

Step 1: Sourcing Content 

In late 2022, Propel began compiling publicly available information from human services agencies across the nation. Most states were providing web pages with instructions directing Medicaid enrollees to a web portal or a phone number to update their contact information. Only a handful offered a submittable online form.    

Step 2: Message Testing

In December 2022, the team piloted outreach in four states that offered different methods for clients to update their contact information. The goal was to understand which channels, online portals or phone lines, and messages increased user engagement. We found that engagement was ten times higher in states that offered online options than in those only offering a call-in option. The team also experimented with emoji use in push notifications and social proofing – the practice of displaying the number of users who have already taken action. Emoji push notifications and social proofing boosted engagement by a staggering 17 and 20 percent, respectively.

Step 3: Scaling Outreach

In February 2023, we applied learnings from the pilot to a nationwide campaign to Providers users enrolled in Medicaid. Initially, we focused on raising awareness around the urgency to renew and the necessary steps to take. 

Over 650,000 users have taken action since to update their contact information after being nudged by push notifications and upon seeing in-app reminders. Nearly 65 percent of those users were first prompted by a push notification, demonstrating the unique value of mobile apps.

Some users reported that the Providers app was how they first learned that they would be at risk of losing their health insurance or that they valued receiving clear, detailed information from a channel outside of the normal interactions with human service agencies.

"This actually notified me of upcoming changes. Often I have issues with not receiving renewal notices from the assistance office yet I later get a letter stating my benefits will stop for not responding to a notice." — Providers user, PA

"Great information. Hadn't seen or heard this anywhere before." — Providers user, SC

"Alerted me to information I wouldn't otherwise have known about." — Providers user, LA

Step 4: Targeted Outreach

With the campaign well underway, Propel analyzed campaign performance metrics and survey data to understand who we were failing to reach. We found that parents with children were viewing our in-app content at lower rates. Developing additional messaging to target and engage this demographic resulted in a 26 percent lift in impressions among this group. 

Step 5: Tracking

As states began mailing renewal notices in April, the campaign’s focus shifted to encouraging users to keep an eye on their mail for a notice and to respond immediately. We also launched an in-app survey to help track user outcomes. Over 65 percent of surveyed users reported successfully updating their contact information after receiving the mailed notice. 

"It describes in detail. An easier way to get and update simple information so no one has to lose their Medicaid who really needs it." —Providers user, NC

"Although I did not have any update, this would have made it very convenient to do so if I did." — Providers user, CO

"This is information I received that wasn't given to me by my case worker or any mailing info. So thank you." — Providers user, MI

Replicable takeaways for continued Medicaid renewals outreach

Private sector partners can support public goals.

An administrative undertaking at the scale of Medicaid unwinding can easily overwhelm state or local agencies. Existing private sector actors building consumer-facing products have the capacity to test messaging, and gather and incorporate user feedback in an agile, iterative environment and support essential public sector goals.  

Leverage existing platforms to deliver and reinforce important messages.

It is essential to meet people where they are already engaged. The Providers app has an extensive and engaged user base that opens the app on average 15-18 times per month – uniquely positioning it to deliver critical communications. 

Mobile apps can facilitate direct client action.

In the age of smartphones and increasing incidence of SMS-based fraud directed at public benefits recipients, mobile apps like Providers can be a powerful way to reach human services clients on platforms that they already use and trust. Push notifications and in-app messaging are familiar  engagement channels that are less likely than text messages and emails to be vectors for fraud. When well-designed, apps not only deliver information but can also effectively engage clients in action. 

Repeat nudges increase the likelihood of client action.

A unique advantage of mobile apps, follow-up nudges are effective reminders and allow users to work around their schedules. According to our analysis, 37 percent of all in-app Medicaid call-to-action content clicks resulted after two or more push notifications. A single additional push alone boosted clicks by 21 percent.

Use multiple channels to maximize messaging efficacy.

Relying on a single channel is insufficient for communicating critical information affecting people’s health and livelihoods. Contact information such as mailing addresses and phone numbers are often outdated. Moreover, in serving such a large population, providing clients with choices that meet their preferences for receiving information is key.   

Employ social proof to maximize engagement.

Social proofing is a strong motivator for action. This was especially true in a situation in which people may have received confusing messages over the past three years about what is necessary and important to do. Our experiments indicated that adding social proofing to in-app content increased user engagement by 20 percent.

Emojis can increase engagement in mobile environments.

While using emojis in communications about a subject as serious as retaining health insurance may seem counter-intuitive, our experiments indicated that adding such visual elements to push notifications increased user engagement by 17 percent.

Offer online options to increase action.

Offering an online option to complete time-sensitive tasks significantly reduces time spent trying to get through to or on hold with customer service hotlines and facilitates immediate action. 

Recognizing the daunting challenge of Medicaid renewals facing state agencies and their customers, Propel launched a multi-stage outreach campaign to stem the potential for devastating repercussions for the more than five million low-income households we serve nationwide – over 80 percent of which were covered by Medicaid last year.

Key campaign stages included: 

1. Research to compile state-specific guidance for users nationwide, 

2. Message testing to identify techniques to increase user engagement and action, 

3. Scaling outreach via repeated nudging to keep the issue top of mind, especially as the required actions change over time, 

4. Targeted outreach to engage hard-to-reach demographics like parents with children, and; 

5. Tracking through surveys to understand what actions users have taken and why. 

Over the last seven months, Propel has reached more than 2.2 Medicaid recipients through Providers. The combination of leveraging a trustworthy and habitual platform, repeat nudging, multi-channel messaging, and providing social proof and visually engaging push notifications led to at least 650,000 taking immediate action to maintain their healthcare coverage.  

Get in touch

If you found this brief helpful, we’d love to hear from you. To share questions or feedback, reach out at info@joinpropel.com.  

Acknowledgements

This brief was authored by a team at Propel, including contributions from Aidan Lovely, Julianna Lai, and Toral Patel. The work to reach our users and connect them to the appropriate processes was led by Emma Hon, Aidan Lovely, Embry Owen and Olivia Peeps.