Redetermination and ENrollment: Evidence at Work (RENEW)

Take-up of safety net programs in the United States is often incomplete, ranging from 84% for SNAP and Medicaid adults to 25% for TANF. Administrative hassles involved with proving initial and continued eligibility, which often require substantial effort by enrollees, may contribute to the large number of eligible but unenrolled individuals and families. The expiration of the nationwide public health emergency related to COVID-19 will trigger eligibility redeterminations for tens of millions of American households and will require many of these households to go through a burdensome and confusing eligibility redetermination process. We propose to study the effect of these administrative hassles in the Medicaid program, where it is estimated that 89 million beneficiaries will be going through the eligibility redetermination process in 2023. Our study has two goals: (1) assess the role of inaccurate beneficiary contact information and administrative frictions in impeding eligibility redetermination and (2) assess the effects of continued Medicaid enrollment on beneficiary health, labor supply, and well-being. We propose a set of scalable interventions, ranging from low- to medium-cost, that are designed to improve the targeting of Medicaid renewal forms, strengthen outreach, and make it easier to complete redetermination applications. Our proposed study will randomize enrollees to one of three treatment arms: (Arm 2) one arm that receives status quo communications from the state after enrollee address information has been updated via enhanced address tracking software; (Arm 3) one that receives enhanced address tracking and outreach services via a partner organization; and (Arm 4) one that receives enhanced address tracking, outreach, and application assistance. The control arm (Arm 1) will rely on existing address information and receive the state’s standard approach to outreach. We will estimate the effects of these treatments on Medicaid renewal rates and retention in the program, shedding light on the degree to which inaccurate contact information and administrative frictions are a barrier to continued enrollment in safety net programs. Further, given that we expect substantial effects on enrollment, we will also estimate effects of continued enrollment on beneficiary health and employment outcomes.