Randomized Communication Nudges to Increase Primary Care Engagement Among Medicaid Enrollees in Maine

In partnership with the Maine Department of Health and Human Services, we conducted a randomized trial of a mail-based outreach strategy to connect newly-enrolled MaineCare members with primary care. Members of MaineCare (Maine’s Medicaid program) who were enrolled in the Primary Care Case Management (PCCM) program were randomized to receive either a standard text-heavy outreach packet (control arm, N=3,350), or the standard mailer plus a visually simplified mailer that emphasizes the value and low-cost of a check-up and recommends a single primary care provider near the enrollee's home (treatment arm, N=862). The intervention was conducted from March 16, 2021 through December 17, 2021, with a follow-up period through December of 2023. This proposal would provide funding for analyzing the results of the randomized trial and disseminating the findings to other researchers and policymakers. We will evaluate whether the simplified enrollment packet resulted in an increase in primary care visits and a decrease in emergency department utilization and hospitalizations (primary outcomes), as well as receipt of preventive services (secondary outcomes). All evaluations will be conducted using MaineCare enrollment and administrative health care claims. Findings will inform state-level strategies for Medicaid programs to connect low-income enrollees with primary care services.