Success story

Simplifying Communications to Help People Maintain Benefits in Louisiana

We built a text messaging service with the state to reduce churn, saving caseworkers and clients valuable time

Impact

  • We sent more than 50 million text message reminders sent to benefit-eligible Louisianans.
  • We integrated four benefits programs integrated into one texting service.
  • We saw a 37% increase in renewals for SNAP clients and 67% increase in renewals for Medicaid clients.

The challenge

“Churn” is a process in which a person’s safety net benefits are discontinued not because they’re ineligible, but because they didn’t complete an administrative step to prove their eligibility. Many of these clients will go on to re-apply for benefits shortly after losing their status, which puts unnecessary stress on families and creates extra work for state administrators. 

For caseworkers and government agencies, churn can be a major financial and logistical issue. In Louisiana, one in four SNAP recipients churn in a given year. Processing these churn cases as new applications instead of renewals costs Louisiana approximately $80 per case, or a total of $18 million annually for SNAP alone. Churn also increases workload for caseworkers, document processing centers, and customer service call centers.

In 2018, we partnered with Louisiana’s Department of Children and Family Services, Department of Health, Office of Technology Services, and the Governor’s Office to create a one-way text messaging service that broadcasts reminders and guidance to clients at key points throughout the benefits enrollment and renewal process.

Our approach

We assembled a multidisciplinary team of researchers, designers, policy professionals, engineers, and project managers to address the challenge of churn in Louisiana. During our three-month discovery period, we learned Louisiana’s SNAP clients experienced instability in their mailing addresses and schedules, and overwhelmingly preferred electronic communication instead of traditional mail. These insights highlighted an opportunity for Louisiana to alter their paper-based communications to meet clients’ needs and ultimately avoid churn.

Working alongside Louisiana’s agencies, we developed LA’MESSAGE, a text message reminder service for Medicaid, SNAP, WIC, and TANF. Initially, we used off-the-shelf tools to start sending one-way text reminders in a matter of weeks. As the pilot evolved, we developed a custom Twilio integration to support increased volume. The first prototype launched in April 2019 with a few dozen WIC clients. Less than a month later, we scaled to hundreds of clients, and to thousands by June 2019. 

An example of two text messages that would be sent to a client reminding them of their certification interview 2 weeks before and 1 week before the appointment

Throughout the pilot, we employed a human-centered approach to focus on the experiences of clients and staff.  When someone churns, it results in a sudden loss of coverage that cuts their families off from critical access to food, medical care, housing assistance, and other services. This cycle causes frustration and confusion for clients, many of whom do not:

  • know about renewal requirements
  • receive or understand renewal communications
  • know how to navigate the burdens of the renewal process
  • understand the consequences of not renewing 

Before we sent our first message, we gathered feedback from clients on what types of information would be valuable to them, and what language was clear and actionable. Using their feedback from interviews, A/B tests, and surveys, we improved message content and delivery. Through A/B testing of a “professional” vs. a “friendly” language framing, we determined that Medicaid clients who received the “professional” text messages returned their renewal packets at a higher rate.

Side-by-side text messages showing a reminder about Medicaid renewal in a professional tone vs. a friendly tone

As clients completed reminder campaigns, we sent optional customer satisfaction surveys to learn more about their experience and give an opportunity for open-ended feedback, and incorporated the results into subsequent campaigns.

Outcomes

The LA’MESSAGE pilot showed text reminders are an effective solution to the challenges safety net clients and caseworkers face. By the end of the nine-month pilot, almost 27,000 residents across four benefit programs agreed to receive texts. These participants saw a nearly 80% increase in kept WIC appointments and a 67% increase in annual Medicaid renewals. Additionally, Louisiana caseworkers saw an increase in responsiveness from these clients. 

The success of the texting pilot allowed Louisiana to build upon and rapidly scale the solution to their entire SNAP and TANF programs during the COVID-19 pandemic. To date, they have sent more than 50 million texts. The Louisiana Department of Children and Family Services continued to support residents by implementing:  

  • Text message reminders for all the state’s SNAP cases (400,000+ households)
  • A public texting campaign to build awareness of and help people apply for SNAP benefits
  • Hiring SNAP recipients to provide feedback on communications and policy decisions

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