CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. 1. Alabama

12/01/2012

As of April 2012, Alabama’s ELE program has been used primarily to streamline Medicaid administrative processing. Alabama’s Express Lane partner agency is the Department of Human Resources, which provides information for ELE processing from SNAP and TANF. Families must still initiate a coverage application or respond to a renewal notice. Most families must also submit the same forms and information as they would without the ELE program in place. However, when state eligibility workers are able to confirm income in SNAP or TANF databases, this finding automatically satisfies Medicaid income eligibility requirements.  Further checking of other databases is not done, which saves time.11 State staff estimate that ELE has been used to assess eligibility (on either initial applications or renewals) for more than 200,000 children.

The Alabama Medicaid Agency (AMA) is implementing its ELE program in five phases, the first two of which are already in place. In October 2009, the program began using income eligibility determinations from SNAP and TANF to process Medicaid renewals for children, and in April 2010 it began using ELE to process initial Medicaid applications for children. Currently, eligibility workers must manually check SNAP and TANF databases to establish income after it has been declared on Medicaid application and renewal forms. In later phases, the state plans to automate enrollment and renewal by matching data with SNAP and TANF records. Later phases also call for extending ELE enrollment and renewal processes to women who are pregnant or accessing the family planning benefit, and for establishing additional agencies as ELE partners, such as WIC.


Table II.1. Features and Implementation Status in Six States with Approved ELE Programs as of December 2010

State Program Using ELE Alabama Medicaid Iowa Medicaid Iowa Separate CHIP Louisiana Medicaid Maryland Medicaid New Jersey Medicaid/CHIP Oregon Medicaid/CHIP
Partner Agency SNAP and TANF SNAP Medicaid SNAP State tax agency State tax agencya SNAPb
Program Strategy SNAP and TANF income findings used to establish income after consumer declarations at application and renewal. Data match to identify potentially eligible children; shortened application form mailed out; SNAP findings establish income eligibility. Medicaid applications and redeterminations showing CHIP-level income automatically referred to CHIP for processing using Medicaid eligibility findings. Automated eligibility, enrollment, and renewal based on SNAP findings. Potentially eligible children identified; shortened application form mailed out. State income tax returns used in process to establish state residence. Data match to identify potentially eligible children; shortened application form mailed out. State income tax returns establish income eligibility. Data match to identify potentially eligible children; shortened application form mailed out. SNAP findings establish income eligibility.
Prior Data Sharing with Partner Agency X X X X   X X
State Plan Amendment Approval Date: Applications June 2010 June 2010 June 2011 January 2010 September 2010 June 2009 October 2010
Implemented for Applicationsc April 2010 June 2010 July 2004 February 2010 September 2008 May 2009 August 2010
State Plan Amendment Approval Date: Renewals November 2009   d January 2010      
Implemented for Renewalsc October 2009   d November 2010      
Implementation Status as of December 2011 Partial Full Full Full Partial Full Full
Enrollments as of December 2011e 50,257 2,065 33,427f 20,240 Unknown 5,321 4,632g
Renewals as of December 2011e 150,000     200,000      

Source: Mathematica interviews with state staff conducted between January and May 2012 and analysis of state administrative data provided by states between January and June 2012.

a New Jersey also has an NSLP ELE program, which has been implemented in all counties as of October 2011. Because it was not in place as of December 2010, the NSLP partnership is excluded from this initial analysis.

b As of December 2011, Oregon was also piloting an NSLP ELE program in four school districts.

c Implementation dates are those recognized by CMS as the program’s “Effective Date” unless available information suggests that a different date more accurately reflects the timing of meaningful changes. Implementation dates for Alabama, Iowa Medicaid, New Jersey, and Oregon are the CMS effective dates. The date for Iowa CHIP was given by state staff in an interview. For Louisiana, the date reflects when children were first enrolled via ELE. For Maryland, the 2008 date reflects the first outreach mailings on the basis of tax return information, which is the event considered by state staff to be the start of ELE in that state; this date also is referenced in Idala et al. (2011). Maryland’s process was not recognized as ELE by CMS until 2010, when the state started using the mailing process to establish in-state residency.

d Iowa’s separate CHIP ELE process does not include renewals. However, children whose eligibility is redetermined by Medicaid, resulting in an ineligibility finding, may be ELE-referred to CHIP, with income-eligibility for CHIP established based on Medicaid’s income findings. This constitutes an ELE transfer, rather than a renewal. eEnrollment counts were computed from state administrative data and reflect the number of enrollments resulting from ELE application processes. Renewal counts reflect estimates provided by state staff during interviews of the approximate number of renewals resulting from ELE renewal processes.
f We requested enrollment data from states for the period beginning one year prior to the ELE program effective date. Because CMS recognizes the effective date for Iowa CHIP’s ELE process as June 2010, we present data on enrollments from June 2009 through December 2011. The number of enrollees since the ELE process began in 2004 is likely much higher.
g As of November 2011.

CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; ELE = Express Lane Eligibility; NSLP = National School Lunch Program; SNAP = Supplemental Nutrition Assistance Program; TANF = Temporary Assistance for Needy Families.


Table II.2. Aims of ELE in Six States with Approved ELE Programs as of December 2010

State Program Using ELE Alabama Medicaid Iowa Medicaid Iowa Separate CHIP Louisiana Medicaid Maryland Medicaid New Jersey Medicaid/CHIP Oregon Medicaid/CHIP
Reduce staff time X X X X   X X
Improve outreach   X   X X X X
Simplify application experience a X X X X X X
Simplify renewal a     X      
Smooth transitions between Medicaid and CHIP     X        

Source: Mathematica interviews with state staff conducted between January and May 2012.

a Since April 2010, self-declaration of income has been accepted for most ELE and non-ELE children, if income cannot be verified through databases accessible to state eligibility staff. This is not the case for children of self-employed parents, for whom income verification is required. Thus, ELE reduces the documentation burden for children with self-employed parents whose income cannot be verified via other databases but can be verified via SNAP or TANF databases.

CHIP = Children’s Health Insurance Program; ELE = Express Lane Eligibility


Table II.3. Applications and Documentation That Applicants Entering Through ELE Route Are Required to Submit

State Program Using ELE Alabama Medicaid Iowa Medicaid Iowa Separate CHIP Louisiana Medicaid Maryland Medicaid New Jersey Medicaid/CHIP Oregon Medicaid/CHIP
Standard application X            
Shortened application   X     X X X
No application     X X      
Standard documentation X       X    
Reduced documentation     X       X
No documentation   X   X   X  

Source: Mathematica interviews with state staff conducted between January and May 2012.

CHIP = Children’s Health Insurance Program; ELE = Express Lane Eligibility.


11 Since April 2010, self-declaration of income has been accepted for most ELE and non-ELE children if income cannot be verified through databases accessible to state eligibility staff. This is not the case for children of self-employed parents, for whom income verification is required. Thus, ELE reduces the documentation burden for children with self-employed parents whose income cannot be verified via other databases but can be verified via SNAP or TANF databases.

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