Mar, 22, 2023

Leveraging Data to Drive Results for Medicaid and Marketplace Enrollment

Julie Bataille, Erica Monteith, and Pedro Suarez, GMMB


To maximize efforts to maintain coverage, state Medicaid agencies and Marketplaces can now leverage digital channels as part of their overall outreach and communications efforts. Rapidly evolving changes in consumer media consumption habits as well as shifts in digital channels, and the ability to leverage data sources, enables granular audience targeting and efficient use of resources. These can be incorporated into an overall integrated outreach and education campaign to maximize renewals and coverage retention. Specifically, digital channels can serve as one of the best ways to reach individuals in places they already are. There are opportunities to utilize these strategies in the coming months to minimize coverage loss as states reinstate Medicaid redeterminations.

Consumer Behavior Changes and Trends in Data and Channel Evolution

To maximize future success, it is important to understand recent changes in media consumption and how said behaviors have affected digital channels. The way individuals in the U.S. watch television (TV) has drastically changed since the onset of the COVID-19 pandemic, with streaming overtaking cable services in 2022 after already surpassing broadcast networks. Streaming is on track to become the preferred method for most viewers in the coming years. More specifically, over-the-top (OTT) streaming has gained a significant presence, as users consume media online rather than through traditional television, or radio. OTT refers to any streaming service that delivers content over the internet, like Netflix, “over-the-top” of an existing internet provider. Additionally, advertising in the U.S. is expected to grow by $80 billion by 2024, led by more digital advertising, with more spending on social media, paid search and internet video. 

Social media usage has also risen dramatically, though what platforms people use often depends on age and income level. In 2021, the use of YouTube and Facebook ranked high across all income levels for U.S. adults. However, individuals earning below $30,000 a year used LinkedIn and Twitter significantly less than those earning more. In addition to the types of social media platforms being utilized, there are also key differences in the way low-income populations access these platforms. Reliance on smartphones solely for online access is higher for adults with lower incomes, as these individuals are less likely to have broadband internet in their homes.

These differences require Marketplaces and Medicaid agencies to maximize effective use of the channels most likely to reach their target audience.

The average consumer’s increased online presence gives advertisers more data to work with, thus maximizing opportunities for effective marketing. Thanks to improvements in data targeting’s specificity, advertisers have started to improve customer-facing digital interfaces, expand their digital offerings, and increase their reach to new locations and demographics, making digital channels like Facebook and Google ideal places to reach consumers where they are spending time throughout their day. As states plan for the unwinding of the Medicaid continuous coverage requirement and their ongoing outreach and education opportunities to drive enrollment in health coverage, changes in consumer behavior offer new ways to efficiently reach target audiences with messages relevant to them.

How States Can Use Digital Channels and Data to Plan Effective Marketing

Leveraging Internal Data Sources

First-party data, or data that is owned by a Medicaid agency or Marketplace, offers information that can help target specific audiences. First-party data includes first and last names, email addresses, phone numbers, and zip codes. Using this data is the most accurate way to ensure resources are directed to existing enrollees and reach them specifically. The data that a state has on hand offers insights into targeting enrollees or potential enrollees and their paths to completing an application for health insurance. Medicaid agencies and Marketplaces can use this information for direct mail, email, text, and telephone outreach and, in some cases, for digital advertising to enrollees whose contact information is already collected. This is also called list targeting or list-based targeting. This allows agencies to use lists of existing contacts for certain types of targeted ads by uploading a list of email addresses to a partner, such as LiveRamp, that can then activate several sites with anonymized data and target those individuals specifically.

Maintaining Compliance with the Health Insurance Portability and Accountability Act

States will need to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) rules by, for example, entering into business associate agreements with platforms when legally necessary. States must also ensure that any disclosures of first-party data comply with federal Medicaid regulations pertaining to privacy protections.

Leveraging External Data Sources

Knowing that some states are interested in potentially targeting Medicaid or Marketplace enrollees without sharing first-party data, there are targeting methods that can be leveraged using income, zip code, and data from third-party sources. To reach eligible individuals and enrollees, we recommend targeting based on eligibility criteria but not specific consumer data. This includes age (18 to 64), income (at and below your state eligibility level thresholds), geography so you reach statewide populations, behavioral-based segments such as shopping patterns (discount stores, grocery stores), and contextually relevant content. Third-party data is information collected more broadly by another entity that does not have a direct relationship with the consumers you are trying to reach.

The U.S. Census Bureau provides free, publicly available data sets that are useful for aggregated demographic and contextual data. The American Community Survey is a good resource that is released annually and helps entities understand changes within their communities by providing detailed information on population and housing. Note that 2020 data from this survey is impacted by the COVID-19 pandemic. The U.S. Census Bureau analytic report released in the Fall of 2021 showed significant non-response bias in the 2020 American Community Survey. The report shows evidence that the data collected over-represents a more socioeconomically and educationally advantaged population. Thus, researchers suggest that 2019 data is the most accurate and up-to-date information to use for outreach planning.


Another way to reinforce your message and ensure it gets to its intended audience is retargeting. Medicaid agencies and Marketplaces can use cookies to track website visitors. When users leave the page without starting or completing an application, the user will see the ads on other sites they visit later. Like remarketing, retargeting allows you to narrow your audience and craft more specific messages without using protected health information (PHI) data. This digital ad strategy increases conversion rates, drives users to the desired page, and allows more relevant messaging to increase consumer awareness.

Channel Considerations

While paid advertising plans will differ based on goals, target audience, budget, timeline, and a variety of other factors, there are some digital channels to consider as part of your investment. Partners such as Facebook offer the ability to create lookalike audiences to discover similar populations to target with campaigns using specific parameters for segmentation. They can use first-party data, but they also have the most scale and ability to target consumers without it.

Facebook allows for a high level of audience targeting, access to an unprecedented number of users and provides advertisers with key analytical insights. When data is shared with Facebook to promote a campaign, the platform’s current policy is that it will only be used internally, not shared or sold, and the use of this data by other clients is prohibited. Once owned data is uploaded to Facebook, it is hashed – making the data non-viewable to the entities it is shared with. Additionally, pre-built audience segments can be added, including geography and age. Facebook allows advertisers to target based on a multitude of factors, including demographics such as, age, gender, educational level, profession; location, zip code, interests, and prior digital behavior. For example, advertisers can target a middle-aged White mother in Virginia without a college degree and a history of discount store shopping.

LiveRamp and MiQ are media buying platforms that can be used for the automated delivery of digital content. They offer the ability to buy digital display, video, and connected TV/OTT inventory across a list of consolidated premium sites, partners, and channels. To increase reach to consumers, they give users the ability to add pre-built audience segments, including geography, age, and income level. This allows advertisers to build ad groups that target specific audiences using factors such as demographics, location, and overall frequency of targeting. With these platforms, for instance, advertisers can target a single young man in Adair County, Missouri by showing him at least three advertisements in one day, but no more than ten in one week.


Changing media consumption patterns and the evolving use of data provide new tools to add to outreach and education efforts to make sure messaging reaches target audiences with information when and where they are consuming information over the course of their day. In marketing to enrollees and potential new enrollees, Medicaid agencies and Marketplaces have opportunities to take advantage of new tactics as well as an imperative to coordinate closely as campaigns are planned and implemented to maximize campaign reach and efficiency, raise awareness about coverage options, guide consumers to essential information, and maximize coverage.