Offering an Internet Survey Response Modein a Flint Water Crisis Medicaid Population

Ford, S.; Oberst, K.; Ilardo, J.; An, H. S.; Jones, N.; Hong, H.; Clark, K.; Luo, Z.

Abstract Objective: To examine the preferred response mode (internet, phone, paper)to a Medicaid enrollee survey. Data Source: Data was obtained from survey responses for a sub-sample of Flint Water Crisis Medicaid Expansion Waiver enrollees (N=2584). Study Design: Enrollees were offered the choice of utilizing the internet, telephone, or mail to respond to a survey evaluating health services. Analyses were stratified by age, residency, race, and income. Chi-square was utilized to detect categorical differences. Principal Findings: The majority (p<0.01) of participants responded by internet (55.46%), followed by mail (39.36%), and telephone (5.19%). Of those responding by internet, 75% used smart phones for connectivity. Weighted participation estimates for available survey modes showed variation by age, residence, race/ethnicity and poverty status. A smaller proportion (p<0.01) of ethnicities classified as Hispanic and Other used telephone participation compared to White or Black respondents. Respondents at 200% Federal Poverty Level (FPL) or higher used internet at greater rates than those below 200% FPL (p<0.01). Conclusions: Overall, this low-income population preferred the web-based response mode compared to paper or telephone, the variation by race and FPL suggests the continued presence of a digital divide in the population. Nevertheless, our findings revealed greater utilization of web-based tools for survey administration in vulnerable populations than was expected. This is a valuable finding that may inform future health programming and telehealth efforts particularly in the advent of COVID-19.