In early 2023, the New Jersey Medicaid agency, or the Division of Medical Assistance and Health Services (DMAHS), approached the Camden Coalition, as one of four New Jersey Regional Health Hubs (RHHs), to assist with the significant task of re-enrolling all Medicaid recipients across the state. In New Jersey, RHHs serve as community backbone organizations supporting the state’s Medicaid program in a variety of ways, including through outreach to Medicaid members.

Medicaid renewal was not required during the pandemic, so in 2023 when the federal government ended the COVID-19 Public Health Emergency, New Jersey, like other states around the country, faced the daunting task of informing its Medicaid members of their requirement to re-enroll in the program. The state’s process, also known as redetermination, involved Medicaid members completing a renewal application primarily sent through the US mail, but a substantial share of Medicaid members did not receive the notification to re-enroll or the renewal package. The re-enrollment process after the public health emergency ended put many people at risk of losing their Medicaid coverage, especially vulnerable populations with complex health and social needs, such as those served by the Camden Coalition.

The Camden Coalition is uniquely positioned to play the role of intermediary between Medicaid and local communities due to its longstanding community relationships and deep understanding of the importance of trusted messengers. In addition to these integral relationships, the Camden Coalition is also able to leverage our Health Information Exchange (HIE), which provides unique access to healthcare records, including contact information for Medicaid members that is more up-to-date than what the state Medicaid program typically has access to. This enhanced data enabled the Camden Coalition to conduct outreach to over 100,000 households across Camden, Cumberland, Burlington, Gloucester, and Salem Counties in the year following the end of the COVID-19 public health emergency.

In 2025, the Camden Coalition continues its partnership with DMAHS and its efforts to contact Medicaid members to remind them to reapply at their annual renewal date –helping keep New Jersey residents stay seamlessly connected to their healthcare coverage.

We sat down with Victor Murray, Senior Director of Community Engagement & Capacity Building, and Aaron Truchil, Senior Director of Data & Quality, to learn more about the program and how the Camden Coalition has continued to refine the redetermination process.  We think these efforts will be even more critical as the state and New Jersey residents eligible for Medicaid brace for new Medicaid enrollment requirements as a result of the federal One Big Beautiful Bill Act or, H.R.1., passed on July 4, 2025.

 How did your teams approach this large-scale project contacting Medicaid members at risk of losing their coverage?    

Aaron: Each month Medicaid would provide us with a series of member files, including the most critical one which was called the Red List. That list included everyone who was midway through the 90-day redetermination period but hadn’t yet responded or submitted all the information that Medicaid needed.

When people sign up for Medicaid, they give an address and often their phone number, but we know we live in an environment where that stuff changes rapidly, especially for folks dealing with unstable housing or other challenges. Every month we loaded that Red List into our Health Information Exchange (HIE), allowing us to match their individual level clinical records and give visibility into a much broader set of contact information than what Medicaid had on file.

We also built a workflow tool for ourselves and the other RHHs that would help assign Medicaid members from the Red List to staff to call based on their capacity. The tool also helped capture key information from the staffs’ conversations with members, like whether members were aware it was time for them to renew their coverage or whether they had received their renewal packet. That way, outreach staff could log into the HIE each month, pull up their outreach list, make calls, and document what happened and key outcomes, all in one place.

Victor: When the redetermination process restarted, we knew right away this couldn’t just be a one-size-fits-all outreach effort. A lot of the folks we serve are juggling a million things like health issues, housing instability, and jobs, and unfortunately sometimes Medicaid renewal slips through the cracks. Our first step was to pick up the phone and call, but we didn’t stop there.

We leveraged our relationships and trust in the community. Our team includes bilingual staff who not only speak the language but also understand the culture, the neighborhood, and the realities people are living with. That made a big difference in how our messages landed. We weren’t just calling from a script, we were meeting people where they were, offering reminders in Spanish or English, and walking them through the steps if they were confused. It was all about making it feel personal and doable.

What changes have you made to the outreach protocol since the program started in 2023? 

Victor: In the first year we found that about 20-25% of people picked up the phone and answered our calls. This was great, but we realized pretty early on that relying on phone calls alone was limiting. Not everyone answers unknown numbers or listens to their voicemails, especially now with all the spam calls going around. So, we started experimenting with text messaging.

The idea was pretty simple. What if we used SMS to reach folks who weren’t picking up our calls? That’s what kicked off our A/B testing which basically compares two versions of a message to see which gets a better response. One group got calls only, and another group got both calls and texts. We wanted to see if layering communication channels could improve connection, and, ultimately, help more people keep their Medicaid coverage.

How are you evaluating the outreach methods that the team has been using and what are the preliminary findings?

Aaron: Given the amount of staff-power that went into reaching out to over 100,000 households, we were eager to evaluate our early telephone-based outreach efforts to determine if – and how – they were contributing to lower Medicaid termination rates. In reviewing the first few months of outreach, we identified some encouraging findings: a completed call (e.g. staff talked to the Medicaid member) was associated with a 12% lower relative risk of coverage loss, even after accounting for other factors that drive coverage loss such as age, household composition, race/ethnicity, gender, and geography. This was a really exciting result, and it motivated us to want to explore whether introducing other forms of outreach could, like text messages, increase the likelihood of members answering our phone call – potentially expanding our impact even further.

Around that time, we connected with NYU’s Rapid Randomized Controlled Trial Lab, a group focused on promoting greater adoption of randomized control trials (RCTs) and A/B testing in the clinical delivery setting. They provided a lot of valuable insights from previous studies, including key lessons learned and practical guidance on how to design and execute these studies effectively.

It took some time to refine exactly what we wanted to study and to work through the logistics – like setting up our systems to randomize households and send out bulk text messages.  We started with a simple strategy: our team sent a text message at the beginning of the month informing individuals that they were at risk of losing coverage, provided a tailored phone number for them to call for assistance, and let them know that our outreach staff would be contacting them shortly. We are still early in evaluating these early A/B tests, but we are seeing some encouraging evidence that the text can moderately increase the phone call pick-up rates, particularly for certain population subgroups, including male-only 18-40 year old households. Over the coming months, we will be refining our evaluations and looking to publish the results more formally.

What might this mean for other complex care providers? What are the next steps for both of your teams?

Aaron: I think these A/B tests should be more embedded into the DNA of programs like ours. We’re going to continue running some of the experiments that we’ve already run and continue to test how to best facilitate renewals. Our next steps will be testing the impact of reaching out to members using only a text message as well as other targeted strategies. We hope that these experiments will help us learn something for both us and the larger community serving people with complex health and social needs.

Victor: I think one big takeaway is that we have to meet people where they are, not just physically, but in how we communicate. A lot of folks who have complex care needs are overwhelmed or cautious about picking up unknown calls. But a text? That feels low-pressure. It gives people time to read it, come back to it, and decide when and how to respond.

For other providers, especially those working with Medicaid populations, it’s a reminder that small changes like adding SMS can make a real difference, especially when budgets are tight and staffing is stretched. Right now, we’re continuing to use texting as part of our outreach, and we’re trying to be thoughtful about how and when we send messages, so they feel helpful, not intrusive.

How is Camden Coalition preparing for the impending changes to Medicaid outlined in the 2025 budget reconciliation bill signed on July 4th?

Victor: We’re getting ready for Medicaid changes with a clear focus on mitigation and infrastructure. Policy shifts like work requirements and more frequent redeterminations will impact people’s ability to stay covered and connected to care, especially those already facing systemic barriers.

On the mitigation side, we will be potentially looking to understand how to support at-risk individuals through targeted outreach, partnerships with community organizations and state agencies, and by equipping trusted messengers like community health workers to guide residents through the new requirements.

On the infrastructure side, we’re exploring how we can leverage our Health Information Exchange to identify individuals at risk of losing coverage and intervene earlier. We’re also working with state partners to ensure the Regional Health Hubs can help assess the real-world impact of these changes through the lens of member experience.

We know these shifts will unfortunately widen disparities even more, but we are undeterred.  We’re leaning into our role as a connector and advocate, making sure community voices shape how systems respond and that we do what we can to ensure our collective safety net holds up.