Call Me Maybe? It Might Help People Stay Enrolled in Medicaid

“Call Me Maybe,” a pop hit from 2011 by Carly Rae Jepsen, may not have much to do with Medicaid. But it conveys an important message: that a single phone call can be powerful. With new evidence from Wisconsin, we see that this remains true, even in a world where other forms of direct communication, like texts and emails, have become more popular.

The One Big Beautiful Bill Act (OBBBA), signed into law in July 2025, contains substantial funding cuts and reforms to Medicaid, the health insurance safety net for tens of millions of Americans. These cuts include twice as many eligibility redeterminations, higher copays, and work requirements of 80 hours per month for Medicaid expansion adults, with some exceptions. Taken together, all these provisions could cause enrollees to forego care or churn in and out of the program. Churn occurs when someone temporarily loses coverage, often due to administrative burdens, like paperwork, or fluctuating income. Unstable coverage is associated with a variety of negative outcomes, such as deferred care and higher costs once re-enrolled.

Medicaid is jointly financed by the federal and state governments, with states having significant discretion to establish eligibility rules, renewal procedures, and other policies that affect how easily individuals can get and keep Medicaid coverage. This leads to some states being generous with eligibility and benefits, and others not so much.

As we enter a federal policy environment that will make it harder for people to retain Medicaid, understanding what tools the states have to counteract coverage loss and churn … is critical.

For instance, some states help people who receive Supplemental Security Income automatically reenroll by sending their information to Medicaid each year before their eligibility expires. There are similar pathways, like Express Lane Eligibility, that have been adopted sparingly because they are too effective. States have lots of information about their enrollees from other sources, like income tax data, but many of them struggle to make use of it to streamline renewals.

Under the Affordable Care Act (ACA), states could extend Medicaid eligibility to individuals with household incomes up to 138% of the federal poverty level. The Supreme Court ruled that the decision to expand was up to the states, and as of 2025, 10 states have not expanded. The more generous income eligibility offered through the Affordable Care Act Medicaid expansion is a powerful vehicle to reduce churn. Coverage disruptions decreased by nearly one quarter, or 4.3 percentage points, in expansion states compared to non-expansion states among adults.

In California, before the ACA, extending the timeline for Medicaid redetermination from 3 to 12 months increased continuous coverage for children by over 20% and reduced hospitalizations. As of 2024, all states were required to have at least 12 months of continuous eligibility for children, rather than it simply being an option. However, under the OBBBA, adults covered under Medicaid expansion will have to re-enroll at least every 6 months. As we enter a federal policy environment that will make it harder for people to retain Medicaid, understanding what tools the states have to counteract coverage loss and churn to support access to care and health is critical.

In a new National Bureau of Economic Research working paper, Rebecca Myerson and colleagues provide some of the first experimental evidence on whether reducing administrative burdens helps Medicaid enrollees retain coverage. Their field experiment was conducted in Wisconsin in partnership with the Department of Health Services and Covering Wisconsin, the state’s insurance navigator program.

Households needing to renew between June 2023 and February 2024 were the target, and over 50,000 of them were included in the experiment. Half were randomized to receive a pre-recorded call, in their preferred language of English or Spanish, offering to connect them with a navigator for free renewal assistance. The control group did not receive a call, but both groups received written outreach from the insurance navigator program—allowing the researchers to test the effect of the call while providing everyone a baseline level of information.

Overall, the intervention increased successful Medicaid renewals by 1.5%. That may not sound like a lot but could mean hundreds of thousands of people staying enrolled if applied nationwide. Crucially, the intervention had an even larger impact on increasing renewal among key groups. Tribal members saw a 13% increase in successful renewals while children, people with chronic conditions, and those with very low incomes all had a 4% increase in renewal.

The OBBBA is poised to accelerate coverage losses and increase administrative burdens on Medicaid enrollees, frustrating them and cutting off their access to health care.

For the subset of people who received the call and accepted the offer of help, terminations due to incomplete paperwork were reduced by a whopping 21 percentage points. Only about 61% of the calls were received, due to invalid phone numbers or full mailboxes, so this intervention could be more effective if the success rate of calls could be increased.

The findings from this field experiment are particularly relevant given that over 17 million people lost Medicaid after the end of the COVID-19 public health emergency because of incomplete paperwork. Many of them re-enrolled within a few months, suggesting it was these administrative burdens, rather than changes in their eligibility, that led to lapses in coverage.

The OBBBA is poised to accelerate coverage losses and increase administrative burdens on Medicaid enrollees, frustrating them and cutting off their access to health care. Given this, states can make simple investments like the one tested in this experiment, for 15 cents per call, to help connect enrollees with support to stay covered.