Health plans are often hampered when it comes to reaching Medicaid members, and while digital marketing and social media have opened up new, effective outreach channels, recent regulations have restricted the targeting capabilities of platforms like Facebook and Google. 


First-party data and new “identity validation solutions” can help, but finding the right person is not enough. Having the right external partnerships can help payers not only leverage new targeting technology, but also take a data-driven approach to modulating impressions, optimizing channels, and testing messages through direct-to-consumer channels. The right partners can help you fail fast, test, learn, and improve to rapidly scale activation and retention. 

The right partners can also help expand access to healthcare services, identify and assess potential health issues, and triage people to the right level of care. This has the potential to reduce systemic disparities, leading to a healthier Medicaid population.

In the State of the Union address, President Biden pledged a $6 billion funding increase in 2023 for mental health support, with an emphasis on “Black and Brown communities, which are disproportionately undertreated.” In February, new research from Twill underscored these claims with data showing that the highest rates of unrecognized depression were observed among communities of color and people on Medicaid. Direct healthcare costs for people with unrecognized depression were 149% higher than they are for people who are not depressed, according to our analysis.34% of medicaid - costs 149% higherThe promise and potential to treat unique patient populations is exciting, but ultimately useless if you cannot reach a patient in need of care. That is why, before you can treat someone, you need effective marketing and outreach. 

Fortunately or unfortunately, marketing never changes. The job is about targeting, messaging, and reach: find the right person and deliver the right message at the right time to get them to take action. Marketing to people on Medicaid is no different, but it presents its own set of unique challenges.  

Medicaid Targeting Challenges 

It’s incredibly difficult to target people on Medicaid for many well-documented reasons, such as the changing eligibility status of enrollees, and what is often a fluid list of contact information. For people who move in and out of the program, and whose home address may change one or more times per year, reaching that person with any type of marketing message can be challenging. 

Medicaid Messaging Challenges

Delivering the right messaging to a Medicaid audience can also be extremely hard. Within the U.S. healthcare industry, the Medicaid population is perhaps the most diverse. In addition to language barriers, and the multi-racial, multi-ethinic makeup that can complicate messaging, the level of healthcare literacy, not to mention trust in the system, can vary greatly. 

Medicaid Reach Challenges

In addition to the challenges of targeting and messaging to people on Medicaid, the final and perhaps most complex hurdle is often just reaching a person on Medicaid with a relevant message. State-by-state regulatory restrictions may require companies to vary the channels they use, or restrict an organization’s ability to do outreach on specific channels like direct mail, email, SMS, texting, and social media. 

The combination of the Medicaid population’s diversity and transience makes targeting, messaging, and outreach very complex.


Changes in Digital Marketing Regulation Impact Targeting 

Over the last decade, states and payers have looked to social media platforms to help them reach members of the Medicaid population—particularly those younger, harder to reach groups. Social media proved to be an effective way to augment the more traditional Medicaid outreach efforts that went through community-based organizations. Demographic and contextual targeting tools offered by digital media platforms like Facebook, TikTok, and Google were increasingly effective at reaching these harder to reach groups. 

However, looming regulatory changes have forced digital giants like Facebook and Google to proactively pull back on their targeting services. These massive businesses—which were built on their ability to capture first-party data from their users, marry that data with a user’s behavior on their platform, and create detailed audience segments that advertisers could use for targeting—have all been curtailed.  

For states and payers trying to reach complex Medicaid populations, these forthcoming regulatory changes could force a pivot back to high-touch community-based efforts, which are extremely resource-intensive and difficult to scale consistently.

The Value of Activation-Based Partnerships

The market response to increased regulation around targeting on digital platforms has been to create a new crop of proprietary targeting tools that make it easier to reach audiences, like people on Medicaid, easier and more effective. 

A host of companies that leverage data in unique ways—from creating custom audiences through the use of first-party data, to leveraging consumer shopping behavior to generate audience profiles—have sprung up to offer new and contextual targeting capabilities. Well-known data and targeting companies like BlueKai (Oracle), Segment (Twilio), Quotient, and LiveRamp (formerly Acxiom) are now competing with targeting services from retailers to help brands reach prospective customers. 

For insurers, the key to successfully using this technology is having external partners who can integrate and optimize all of the different outreach & engagement components into a coordinated, data/performance-driven, multi-channel function that operates both inside and outside the Medicaid regulatory framework.

Why Do Payers Need External Partners? Can They Do It Themselves? 


Given the highly-regulated Medicaid environment, health plans are limited in what they can say, and where and how they can say it. These limitations make a wide swath of engagement tactics unavailable, or difficult and slow to leverage, for payers. 

Moreover, many consumers—particularly in the Medicaid space—may not be used to, or comfortable with, turning to an insurance company for information. Some populations are particularly wary. For example, a 2020 poll by the Kaiser Family Foundation found that 55% of Black Americans distrust the healthcare system, which can lead to delays in treatment and care.

The right external partner can both enhance a health plan's existing communication channels and take advantage of other channels and data sources to activate and engage individuals, all while maintaining total compliance.

Segmentation, Localization, & Optimization 

One of the things Twill does exceptionally well is the localization and optimization of content for different audience segments. 

Twill has gotten adept at localizing content internationally, because our digital therapeutic platform is available in 10 languages, in 190 countries. During COVID, we accelerated our localization efforts to support the diversity of domestic users, and we quickly saw engagement jump 20%.


Here are a few examples:

  • To address race-based stress and trauma from discrimination,  we partnered with Dr. Clifton Berwise of the University of Delaware to create a tailored digital program for Black Americans
  • We localized content to support burned out healthcare workers
  • We designed a multi-disciplinary digital mental health solution designed for adolescent users
  • To combat the AAPI community’s increased levels of fear and anxiety after an uptick in hate crimes, we collaborated with therapist Michelle Pow to develop a custom program for the Asian communityHAP_058_Medicaid_Article_Graph_4

In each case, the Therapeutic Media™ to support these programs (video, audio, articles, activities, etc.) was designed and launched in under six weeks. Once developed, highly relevant and targeted marketing messages were tested and deployed in short order to maximize engagement.  

Activation & the Conversion Funnel

The old saying, “you can lead a horse to water, but you can’t make them drink,” is often true when it comes to marketing a new service to people. Getting prospective customers to click on ads and go to websites is easier than getting them to sign up for the product and use it. That is why it’s critical to optimize your conversion funnel. 

The goal of any activation campaign is to use the best available data to connect the right audience, through the right channel, with an effective message that gets that customer to use helpful digital healthcare tools. 

The right external partner can extend a health plan’s reach through the use of 2nd- and 3rd- party data; test messaging and content to increase engagement; and use digital marketing channels more freely, building off of the native targeting capabilities of platforms like Instagram, TikTok, and Google. 

But even if you reach the right customer through the right channel with the right message, your online experience needs to keep prospective customers engaged from the time they're introduced to a product, to the time when they’ve completed a sign-up and actually used the product. 


For example, the continual optimization of the enrollment experience in Twill’s psoriasis community increased the visit to sign-up rate by 40%. Twill’s product team conducted multivariate testing of our landing pages, photos, and enrollment page copy in an effort to improve the visit-to-sign-up rates. 

Often, for carriers, that kind of optimization and testing is only possible at scale through partnerships. 

As the Head of Twill’s Activation team, I’m inspired by the work we are doing with health plans to improve outcomes for their Medicaid members. And the use case here—psoriasis—could easily be another condition, disease, or life stage, depending on the specifics of a health plan’s priorities. 

The goal of reaching more people on Medicaid is to shorten the distance between need and care, so that everyone has access to the care they need, when they need it, and in the way they want.