The Impact of Modest Cash Incentives on Home Visiting Enrollment and Participation

We present initial and persistent effects of an experimental evaluation of monetary incentives in the context of a Medicaid home visiting program for pregnant individuals. A total of 218 participants enrolled in this study between April 1, 2019, and October 1, 2020. Our sample includes Medicaid-enrolled pregnant people referred to the home visiting program who verbally agreed to enroll in the program and scheduled their initial home visit, but had not yet completed this first visit. We randomly assigned individuals to groups based on their date of birth: (1) members of one group received $20 cash for keeping their enrollment appointment; (2) members of a control group did not receive an incentive at their enrollment appointment. We find that offering incentives increased the likelihood of completing the enrollment appointment and at least one subsequent appointment. The impact on keeping the enrollment appointment was substantially larger for Black families than for families of other races. There was no impact on keeping the first appointment when the visit was conducted via telehealth. Increasing rewards for completing an enrollment visit may expand access to information about the program’s risks and rewards, leading some to continue participation beyond that first appointment. One-time incentives may not be enough to encourage full program participation.