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POLICY INSIGHT
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States Can Use Text Messaging to Communicate Effectively With Medicaid and SNAP Enrollees

State agencies administering programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP) need to communicate important information with their clients, such as when people should renew their benefits or submit verification documents. While agencies often rely on mailed notices for these communications, they can more effectively reach many clients by adding text message reminders.

Although the Telephone Consumer Protection Act (TCPA) places certain restrictions on texting without the express consent of clients, state governments can send text messages without facing liability under the TCPA. A 2021 ruling on the TCPA by the Federal Communications Commission (FCC) cleared the path for states to develop and deploy automated texting campaigns to inform beneficiaries of critical enrollment-related information. This includes information on pending expiration of the COVID-19 public health emergency (PHE), instructions to update their contact information, notices to complete a renewal or report changes, information about benefit changes, and resources for additional assistance.

With the majority of adults in the U.S. ― 97 percent ― owning a cellphone, automated text messages are an effective and efficient tool for improving client communication in programs such as Medicaid and SNAP. For example, a pilot program in Louisiana sent text reminders about renewals to clients, which resulted in 10 and 19 percentage point increases in successful Medicaid and SNAP renewals, respectively.

Despite the proven success of text messaging, there remains uncertainty about the implications of the TCPA — which makes it illegal for “any person” to send automated texts without prior consent and penalizes organizations for failing to comply. Consequently, many states are hesitant to implement automated texting without the cumbersome process of obtaining and tracking an explicit “opt-in” from clients. The 2021 FCC ruling, however, excluded state governments from the definition of a “person.” Therefore, state governments can communicate information to beneficiaries via text messaging without first obtaining their “opt-in” and without facing liability under the TCPA.

State agencies administering economic security and health programs such as Medicaid and SNAP will soon face a significant increase in workload when the PHE ends. At that point, state agencies will need to resume regular operations, including Medicaid renewals for enrollees who may not have been in contact with the Medicaid agency for over two years, and unwinding of pandemic-related SNAP benefits. Many enrollees also may have moved during the pandemic without updating their contact information with the agency. As the PHE expiration approaches, states can take proactive steps to reach enrollees, including through text messages, to ensure eligible enrollees maintain continuity of benefits and understand programmatic changes.

TCPA restrictions currently apply to local governments that administer benefits as well as contractors, such as managed care organizations, and these entities (in contrast to states) may need to obtain consent before texting their clients. However, the Department of Health and Human Services has sought clarification from the FCC on possible exemptions for such entities; the request is pending.

Despite the uncertainty for local governments and contractors, in the vast majority of states where Medicaid, SNAP, and other economic security and health programs are administered at the state level, agencies can and should send text messages to their clients to help eligible people connect to and stay enrolled in these programs.