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The 2014 Affordable Care Act (ACA) health coverage expansions provide millions of uninsured Americans a new coverage option through Medicaid or Health Insurance Marketplaces. Mobile technology includes a growing array of handheld or portable electronic devices such as cell phones, smartphones, and tablets. Adults use their cell phones for a variety of tasks, including text messaging and as their primary way to access the Internet. Low-income adults and people of color who are cell phone owners are particularly likely to use their phone as their primary way to access the Internet. There has been growing interest in using text messaging and mobile technology in health care. Text4baby is a free, personalized maternal child health education program that uses text messaging to provide health and safety information and support to pregnant women and new mothers.
In February 2012, Text4baby partnered with the Connecting Kids to Coverage initiative of the Centers for Medicare and Medicaid Services to drive enrollment in Medicaid and CHIP through a series of interactive text messages.
In late summer 2013, the Kaiser Commission on Medicaid and the Uninsured and PerryUndem Research and Associates conducted structured telephone interviews with 43 women enrolled in Text4baby to take a qualitative look at the impact of the Medicaid module.
Text4baby respondents included young, low- and moderate-income women with diverse racial and ethnic backgrounds.
Most respondents had limited knowledge of Medicaid and CHIP when they signed up for Text4baby. Many respondents said they sought out additional information about Medicaid and CHIP after receiving Text4baby’s messages about health coverage. A number of the respondents said they applied for Medicaid or CHIP for themselves or an uninsured child after receiving Text4baby’s messages about health coverage. With the continued rise in the use of mobile technology across the population, including lower-income and diverse groups, text messaging can serve as a useful vehicle to reach and communicate with uninsured individuals.
This issue brief is part of a Kaiser Commission on Medicaid and the Uninsured series of profiles on Medicaid and CHIP Outreach and Enrollment Strategies. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California. Our owned and operated high speed wireless network serves the majority of our members' usage.
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Previous studies have shown that young adults send an average of 109.5 text messages a day or approximately 3,200 texts each month.
Baylor University is a private Christian university and a nationally ranked research institution, characterized as having "high research activity" by the Carnegie Foundation for the Advancement of Teaching. Baylor University's Hankamer School of Business provides a rigorous academic experience, consisting of classroom and hands-on learning, guided by Christian commitment and a global perspective.
Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. However, effective outreach, enrollment, and retention efforts are essential for ensuring that these new coverage opportunities translate into increased coverage. It is estimated that, as of May 2013, 88 percent of Hispanics, 93 percent of Blacks, and 90 percent of Whites owned cell phones. More than 4 in 5 adult cell phone owners (81%) use their cell phone to send or receive text messages, including 87 percent of Hispanics and 85 percent of non-Hispanic Blacks.7  Moreover, data suggest that 99 percent of text messages are read, with 91 percent of them read within three minutes8 Six in ten cell phone users (60%) access the Internet on their phones and over half (52%) use their cell phones to send or receive email (Figure 1). Among adult cell phone owners, Hispanics are significantly more likely than Whites to use their cell phones to send or receive text messages (Figure 2). As part of this “Medicaid module,” three days after enrolling in Text4baby, individuals are asked about their type of health coverage.

All interview respondents were uninsured themselves or had at least one uninsured child when they enrolled in Text4baby and recalled receiving the text messages in the Medicaid module. Many of the Text4baby respondents reported that they primarily connect to the Internet through their cell phone. At the time they enrolled in Text4baby, most said they had never been covered by Medicaid or CHIP or tried to sign themselves up for Medicaid or CHIP in the past.
Some visited the Insure Kids Now website through their phone or computer or called the Insure Kids Now toll free number. Experience with the Text4baby Medicaid module shows that individuals found text messages about health insurance to be useful and that the messages helped spur them to seek out additional information about health coverage and apply for coverage.
The authors would like to extend their appreciation to Text4baby for providing data used in this report. Outside of our network, they are covered coast to coast through partnerships we have with numerous national and regional wireless carriers. 28, 2012) - Cell phone and instant messaging addictions are driven by materialism and impulsiveness and can be compared to consumption pathologies like compulsive buying and credit card misuse, according to a Baylor University study in the Journal of Behavioral Addictions. Cell phones are used as part of the conspicuous consumption ritual and also act as a pacifier for the impulsive tendencies of the user, according to Roberts.
According to Roberts, materialism is an important consumer value that impacts many of the decisions we make as consumers. They receive an additional 113 text messages and check their cell 60 times in a typical day and on average, college students spend approximately seven hours daily interacting with information and communication technology.
The university provides a vibrant campus community for approximately 15,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Recognized nationally for several programs, including Entrepreneurship and Accounting, the school offers 24 undergraduate and 13 graduate areas of study. Although adults with higher incomes and educational attainment levels are more likely to own a cell phone than those with lower incomes and education levels, cell phone ownership is still high among low-income adults and those with lower education.
Hispanic and Black adults are also significantly more likely than their White counterparts to use their cell phones to access the Internet and to do so mostly on a cell phone instead of on another device such as a computer, laptop, or tablet.
For example, as highlighted in a previous outreach and enrollment strategy profile, the Michigan Primary Care Association achieved success increasing retention through an innovative text messaging strategy that reminds Medicaid and CHIP enrollees about the need to renew Medicaid coverage and offer renewal assistance to families.12 Similarly, the National Alliance for Hispanic Health launched a text messaging service called the Buena Salud Club to provide free, bilingual health and health coverage information to Hispanic consumers through text messaging. Those who respond with Medicaid or CHIP are then texted a supportive message and information on how to renew their coverage. Those who are uninsured are texted information about Medicaid and CHIP eligibility and how to enroll. Respondents included both those who already had children in the home and those who did not yet have any children in the household. In a number of cases, respondents who said they primarily connect to the Internet through their phone indicated that they do not have access to a computer at home or work.
However, some reported that they knew a good amount or a lot about the programs, with a number having been previously enrolled in Medicaid and CHIP. Some tried to learn more about coverage by talking to a health care provider, family and friends, someone from Medicaid, CHIP, or another government office, or a trusted individual in their community. Looking ahead, as outreach and enrollment efforts for the ACA coverage expansions continue, these findings suggest that text messaging could be an effective outreach and education tool. Impulsiveness, he noted, plays an important role in both behavioral and substance addictions. Additionally, cell phone use and over-use have become so common that it is important to have a better understanding of what drives these types of technological addictions.
Cell phones are used by approximately ninety percent of college students, and said Roberts, "serve more than just a utilitarian purpose". Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating university in Texas.

To provide greater insight into the potential role of text messaging as an outreach vehicle, this brief focuses on the use of standard cell phones and smartphones for text messages and Internet access and illustrates how one text messaging initiative, Text4baby, a free, personalized maternal child health education text messaging service for pregnant women and new mothers, is helping eligible pregnant women and their families connect to health coverage. Nearly nine in ten adults (86%) with annual income below $30,000 and 83% of adults with less than a high school education owned a cell phone as of May 2013.
The use of both text messaging and cell phones to access the Internet has risen dramatically in recent years, especially as smartphones have become more popular.
Similarly, lower income adults are more likely than those at higher incomes to say that they mostly access the Internet through their cell phone.
13  Beginning in 2012, Text4baby, a personalized maternal and child health program, also launched a text messaging outreach and enrollment campaign to connect more pregnant women and their families to Medicaid and CHIP.
Recently, Text4baby incorporated use of a series of text messages, referred to as the “Medicaid module,” which were designed to increase enrollment of uninsured pregnant women and their families into Medicaid and CHIP. They also receive a follow-up text seven days later asking if they applied for coverage (Figure 4).
They also included women of diverse racial and ethnic backgrounds and immigration statuses, with a number speaking a language other than English in the home. A smaller number of respondents reported mostly connecting to the Internet through the computer and several said they use a cell phone and computer equally.
Most respondents who reported applying for Medicaid and CHIP indicated that Text4baby’s messages about health coverage were an important factor in their decision to apply for Medicaid and CHIP. Other experience suggests that text messaging may also be an effective tool to facilitate renewals of Medicaid and CHIP coverage.
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Cell phones are accessible at any time, including during class, and possess an ever-expanding array of functions, which makes their use or over-use increasingly likely.
Located in Waco, Baylor welcomes students from all 50 states and more than 80 countries to study a broad range of degrees among its 11 nationally recognized academic divisions.
Cell phone ownership is also high among adults across age groups and urban, rural, and suburban contexts. Moreover, compared to Whites and those with higher family income, Blacks and Hispanics and low-income earners are less likely to use the Internet or email at home (Figure 3). Almost all respondents reported having household income of less than $40,000, with a number reporting income below $20,000 per year. Moreover, regardless of whether they applied for Medicaid and CHIP, nearly all respondents said they found the Text4baby messages useful and said that they would like to receive more text messages about health insurance in the future. Given that some individuals primarily rely on cell phones to connect to the Internet, it may be useful to explore options that would enable individuals to apply for and renew health coverage directly through their phone. A majority of young people claim that losing their cell phone would be disastrous to their social lives, he said. Baylor sponsors 19 varsity athletic teams and is a founding member of the Big 12 Conference.
Overall, with the continued rise of use of mobile technology, it will be important to continue to explore its potential uses in enrolling and maintaining health coverage.

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