May, 16, 2024

Optimizing SMS Strategies for Outreach to Medicaid and Marketplace Enrollees

Melissa Morales and Kenzie Perrow, GMMB; Kaylee O’Connor, Manatt Health

As states continue to explore new ways to reach Medicaid and Marketplace members with targeted messages and updates about their coverage, many have incorporated SMS text messaging into their communications plans. The January 2023 Federal Communications Commission ruling affirmed that state agencies and their partners may send text messages and make phone calls to individuals about enrollment-related issues in compliance with the Telephone Consumer Protection Act. For more information about the ruling, see SHVS’ expert perspective, Federal Ruling Provides Text Messaging Flexibility to Support State’s Unwinding Efforts, which reviews implications for states.

This expert perspective highlights strategies and recommendations for states that are considering or currently implementing text messaging in their outreach plans to support states as they look to optimize text messaging in their Medicaid and Marketplace communications and outreach efforts.

The Value of SMS Campaigns

Now that standard Medicaid renewal processes have resumed, states need to be able to contact members with information about their eligibility status—which may include sending a renewal form or a request for information needed to determine eligibility. The redetermination process following the unwinding of the Medicaid continuous coverage requirement has demonstrated the critical need for states to maintain multiple points of contact with members. As has been apparent from publicly available data pertaining to procedural denials, many Americans lost coverage simply because they couldn’t be contacted by their state Medicaid agency.

To mitigate disenrollments for procedural reasons, the Centers for Medicare & Medicaid Services’ (CMS’) eligibility and enrollment final rule requires states to take action in response to returned mail from enrollees. Specifically, states must establish a process to regularly obtain and act on updated enrollee address information. If updated address information cannot be obtained or confirmed as reliable, states are newly required in certain instances to make a “good faith effort” to contact the enrollee using two or more modalities—which may include text messaging.[1]

Research shows that Medicaid members are more likely to respond to requests for updated contact information when contacted through text messaging rather than mail or email. Members also shared a preference for multiple methods of communication in addition to mailed notices when receiving information about their coverage.

States have an opportunity to apply lessons learned from unwinding to improve, grow, or even start their SMS programs in Medicaid and the Marketplace to effectively remain in contact with members and ultimately support them through their coverage journey.

SMS Best Practices

States may consider the following best practices when sending text messages to members and following up on returned mail to obtain or verify updated contact information.

  • Keep it short. SMS messages that exceed 160 characters will be broken into multiple text messages. If you cannot limit your message to 160 characters, consider delivering it through email instead.
  • Identify yourself. Make sure the message indicates who is sending the text.
  • Don’t send too frequently. Limit your communications to two to four SMS messages per month, and never send more than eight messages altogether. Any more and you risk frustrating your members, leading them to unsubscribe. Tell them how often they can expect to hear from you, and be sure to prioritize critical messages, deadlines, and alerts to take action.
  • Tell, don’t ask. Ensure that your messages provide a clear call to action. Make it easy for members by giving them the information they need to act quickly, such as links, phone numbers, and addresses. 
  • Timing is everything. If text messages are sent during inappropriate hours, members may ignore them. Be sure your SMS messages are sent during hours that are convenient for members to improve responses (see below for recommendations regarding timing).
  • Experiment with audience segments. Once you have a handle on your SMS campaign, test sending targeted, tailored messages to different audience segments. 
  • Non-English campaigns. If your text messaging campaign is in a language other than English, use a professional, local interpreter to ensure your message is culturally and linguistically appropriate. Avoid errors and irrelevance that often stem from using automated online services such as Google Translate. If you’re directing consumers to get in-person help, ensure someone will be available to assist them in their preferred language. Remember that your English text may be under 160 characters, but that likely means you will need more characters for translation into other languages.
  • No marketing. Text messages should be solely about maintaining enrollment and should not market a managed care plan or anything else.
  • Let members opt out. Tell members how they can opt out of receiving any further texts. And if they choose to opt out, make sure to follow their instructions.
  • Check the Reassigned Number Database (RND). Members sometimes switch cell phone numbers. By checking the RND before sending a text, you help reduce the chance of texting the wrong person.

SMS Testing

Testing SMS tactics is key to understanding what resonates most with your audience and drives them to complete the actions you want them to take. Consider testing the following factors in your SMS campaign to optimize results:

  • Timing. Overall, mid-week afternoon notifications have the highest click rates, but that can vary. Analyze your agency’s data to determine your audience’s most engaged hours, then test a few days and times and optimize based on those results. 
  • Voice. Try using emojis, a conversational tone, or creating a persona for your SMS messages to foster a more engaging experience with audiences. Track what recipients respond to most. 
  • Message. Test different calls to action and diversify your language from time to time to avoid repetitive messages.
  • Link placements. Compare the link placement at the top of your text to the mid-copy or the bottom and track the click-through rate. 


Note: You can test almost any factor in your campaign. However, testing only one variable at a time is important to ensure that the campaign’s outcome can clearly be attributed to the factor you changed. 

State Spotlight: Oklahoma

In 2023 and 2024, Oklahoma moved away from a fee-for-service model toward a new value-based payment delivery system for medical and dental plans offered to members through SoonerCare, the state’s Medicaid program. The plans administered by the Oklahoma Health Care Authority (OHCA) in partnership with contracted entities were branded as SoonerSelect. This transition required members moving to SoonerSelect to choose their new plans during an open enrollment period. OHCA implemented a communications campaign called “Pick a Plan” to educate members and promote active plan selections.

OHCA set a goal of meeting an 18% threshold for active plan selections. Among other outreach tactics, OHCA leveraged SMS to drive conversions. OHCA secured SMS messages at no cost from its Office of Management and Enterprise Services. With ten days remaining in the open enrollment period, OHCA held an active plan selection rate of 10%. OHCA sent two text messages to more than 237,000 members with a listed mobile number who had not yet enrolled in SoonerSelect. Based on member preferences, the message was distributed in English and Spanish, prompting individuals to pick a health plan while highlighting the upcoming open enrollment deadline.

This second round of text messages was accompanied by a targeted email for members with a listed email address. As a result, OHCA’s health plan selection increased by an average of 135% the day after sending each text message and email, jumping from 6,000 enrollments per day to more than 14,000 – ultimately doubling the state’s plan selection rate from 10% to 20%, surpassing their goal. OHCA’s success serves as an example of how states may utilize SMS strategies for timely and targeted outreach to drive enrollment.

Available Resources

Sample text messages are available in English and Spanish for state Medicaid programs to use through the SHVS Social Press Kit. Messages are customizable and should be adjusted, as needed, to apply language that is most likely to resonate with states’ respective audiences.


[1] For more information, see slides 18 and 19 of SHVS’ webinar presentation, CMS Final Rule on Medicaid and CHIP Eligibility, Enrollment, and Renewal.