CHIPRA increased CHIP funding and gave states new flexibility to expand eligibility and increase participation rates among eligible children. CHIPRA authorized states to use Express Lane Eligibility (ELE), under which state CHIP or Medicaid agencies can use another public program’s eligibility findings to make them eligible for health coverage.5 For example, Louisiana’s Department of Health and Hospitals chose the Department of Children and Family Services, which administers the Supplemental Nutrition Assistance Program (SNAP, formerly known as “Food Stamps”), as its partner in enrolling and renewing eligible children in Medicaid. Ten percent of children’s new Medicaid enrollments, and twenty percent of children’s Medicaid renewals, now come through ELE, and implementing ELE saves Louisiana nearly $1 million per year in administrative costs.6
CHIPRA also included outreach and enrollment grant funding to promote effective enrollment and renewal strategies (continued under the Affordable Care Act); provided performance bonuses for states adopting innovative approaches to covering more children; and extended automatic eligibility to newborns whose mothers are covered by CHIP.7 CHIPRA, finally, gave states the option to eliminate the 5-year waiting period for immigrant children who are lawfully present in this country. More than half the states have done so.8
On the first anniversary of CHIPRA, February 4, 2010, Secretary of Health and Human Services Kathleen Sebelius issued her Connecting Kids to Coverage challenge, asking states and communities to help enroll eligible uninsured children in CHIP and Medicaid. Too many uninsured children appeared to be eligible for CHIP or Medicaid but were unenrolled. By 2012, the estimated number of eligible uninsured children had dropped from 4.9 million in 2008 to 3.7 million, and the estimated percentage of eligible children enrolled in Medicaid or CHIP had increased from 82 to 88 percent.9 This progress, moreover, came at a time when economic conditions placed more children below Medicaid or CHIP income eligibility limits.