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The OBBBA represents a paradigm shift in the management of the American social safety net. By requiring beneficiaries to prove their eligibility every six months—down from the previous annual requirement—the legislation significantly increases the administrative burden on both the state and the individual. Research from the Urban Institute suggests that such frequent redeterminations could drastically reduce Medicaid expansion enrollment, creating a "churn" where eligible individuals cycle in and out of coverage due to paperwork errors or missed deadlines. This "chaos and confusion," as described by various state governors and health advocates, is compounded by the reintroduction of work requirements, a policy previously attempted during the first Trump administration that faced significant legal and logistical challenges. Under the 2025 Act, states are now legally bound to notify those affected by these shifting requirements, but the federal government has left the specific methods of that outreach largely to the discretion of the states, provided they use at least two channels.
In anticipation of this administrative bottleneck, health policy researchers have been investigating which outreach strategies are most effective at maintaining coverage for eligible participants. A recent comprehensive study led by researchers from Emory University, the University of Wisconsin-Madison, and Texas A&M University provides a data-driven roadmap for states. Working in conjunction with Covering Wisconsin—the state’s health insurance navigator program—the research team evaluated how different communication modalities influenced Medicaid renewal rates and "procedural disenrollments." A procedural disenrollment occurs when a beneficiary loses coverage not because they are over the income limit, but because they failed to complete the required paperwork, often due to never receiving the notice or finding the instructions too complex to follow.
The study’s methodology involved a randomized trial testing three primary outreach tools: traditional postcards, text messages, and prerecorded automated phone calls. For ethical reasons, every participant in the study received at least one form of written outreach. However, the researchers varied the delivery method and supplemented some notifications with phone calls to measure the incremental impact. The findings offer a stark look at the efficiency and efficacy of modern communication in the context of public health.
The first major takeaway from the research involves the comparison between physical mail and digital text messaging. In an era where many low-income households move frequently or face unstable housing, traditional mail can often fail to reach its intended recipient. The study found that there was no statistically significant difference in renewal rates between those who received a postcard and those who received a text message. However, the cost implications were profound. While a postcard costs approximately 38 cents per contact when accounting for printing and postage, a text message costs a mere 9 cents. For state agencies operating under tight budgets—especially following the recent 90% federal funding cut to the navigator program—the ability to achieve the same results at a fraction of the cost makes text messaging an essential tool for the 2027 rollout.
The second key finding highlights the power of multi-channel engagement. The researchers found that supplementing written outreach (whether via mail or text) with a prerecorded phone call offering assistance from a health insurance navigator significantly boosted renewal rates. Specifically, the addition of a call increased Medicaid renewals by 1 percentage point and reduced procedural denials by the same margin across the entire study group. When looking only at the individuals who successfully received and answered the call, the impact was even more pronounced: a 1.7 percentage point increase in renewals and an 1.8 percentage point decrease in procedural denials. While these percentages may seem small in isolation, when scaled to a national level involving tens of millions of Medicaid enrollees, they represent hundreds of thousands of people who would otherwise lose access to healthcare.
The economic argument for these interventions is equally compelling. The study noted that the technological cost of an automated call is roughly 15 cents. When calculated against the success rate, the cost of "saving" a Medicaid enrollment via this method is approximately $15 per person. This is an extraordinarily low price point when compared to the societal and economic costs of individuals becoming uninsured, which often leads to increased emergency room visits, uncompensated care for hospitals, and poorer long-term health outcomes that ultimately increase public spending.
Furthermore, the research underscored the disproportionate impact of administrative barriers on specific demographic groups. The effectiveness of prerecorded calls was most significant among Native American tribal members, children, and individuals living with chronic health conditions. Among tribal members in the Wisconsin sample, more than one in three individuals lost coverage for procedural reasons—a staggering statistic that highlights how "red tape" can inadvertently become a tool of systemic exclusion. While some provisions of the OBBBA exempt tribal members from certain requirements, the administrative friction of the redetermination process remains a threat to their continuity of care. Similarly, for those with chronic conditions, a gap in coverage of even a few weeks can mean the difference between managing a condition and facing a life-threatening crisis due to an inability to afford prescription medications or specialist visits.
One of the most significant hurdles identified by the researchers—and one that states must address before September—is the integrity of contact data. The study revealed that at least 20% of the phone numbers or physical addresses on file with the state were outdated or incorrect. This means that even the most well-crafted outreach strategy is destined to fail for one-fifth of the population if the underlying data is not refreshed. Interestingly, the One Big Beautiful Bill Act of 2025 includes a provision that might offer a partial solution to this "dirty data" problem. The bill establishes a framework for managed care entities (private insurers that contract with the state to provide Medicaid services) to share updated contact information with state Medicaid agencies. Since these insurers often have more frequent touchpoints with members than the state government, this data-sharing could prove vital in ensuring that renewal notices actually reach the hands of the beneficiaries.
The role of navigators—trained professionals who help individuals sign up for and maintain health insurance—is also at a critical juncture. Since their inception under the Affordable Care Act in 2013, navigators have served as the "boots on the ground" for enrollment efforts. However, the recent 90% cut in federal funding for the navigator program has left these organizations reeling. The Wisconsin study suggests that tech-enabled outreach, such as automated calls and texts, can help these diminished teams work more efficiently by identifying and triaging those who need the most help. By automating the initial notification and offering a "press one to speak to a navigator" option, states can maximize the impact of their limited human resources.
As the 2027 implementation date for the OBBBA’s work requirements and bi-annual checks approaches, the lessons from the Wisconsin study are clear: states cannot rely on a "business as usual" approach to communication. The transition from annual to semi-annual redeterminations effectively doubles the administrative workload for both the state and the enrollee, creating twice as many opportunities for an eligible person to fall through the cracks of the bureaucracy. To prevent a massive spike in the uninsured rate, states must adopt a diversified, tech-forward outreach strategy that prioritizes low-cost, high-impact channels like SMS and automated voice messaging.
Ultimately, the success of the Medicaid program under the new legislative framework will be measured not just by its ability to root out fraud or encourage work, but by its ability to remain accessible to those it was designed to protect. The findings from Myerson, Espeseth, and Dague serve as a vital warning and a guide. If states fail to modernize their outreach methods and address the underlying issues of data integrity and administrative friction, the "One Big Beautiful Bill" may leave a legacy of "chaos and confusion" that undermines the health and financial stability of millions of American families. With the notification period beginning this September, the time for states to finalize these strategies is now. The cost of inaction is far higher than the 15 cents it takes to place a phone call.
