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

12/01/2012

Section 203 of CHIPRA requires that the ELE evaluation include four components:

  1. An evaluation of the administrative costs or savings related to identifying and enrolling children through ELE methods compared to the costs of identifying and enrolling eligible but unenrolled children through the state’s regular methods
  2. An assessment of whether ELE improves a state’s ability to identify and enroll eligible but unenrolled children
  3. Recommendations for legislative or administrative changes that would improve ELE’s effectiveness as a method for enrolling or retaining children in Medicaid or CHIP
  4. A report on the percentage of children erroneously enrolled in Medicaid or CHIP based on the Express Lane agency findings8

Table I.1 summarizes how the evaluation will address each of the four components. Key methods include a descriptive study of program costs, enrollment, and utilization; an impact analysis, using data from the CHIP Statistical Enrollment Data System (SEDS); case studies; and an assessment of the state policy context, through an information review, a 51-state survey, and quarterly interviews with non-case study states. Two cross-cutting reports implementing the statutory requirements will synthesize these findings: (1) this Interim Report to Congress; and (2) the Final Report to Congress.


Table I.1. Evaluation Components Mandated by Congress and Methods Planned to Address Them

  Methods to Address Evaluation Components Reporting
Evaluation Components Mandated by Congress Program Cost, Enrollment, and Utilization Study SEDS Enrollment Impact Analysis ELE and Non-ELE Case Studies Information Review, Quarterly Interviews, 51-State Survey Interim Report to Congress (2012) Final Report to Congress (2013)
1. An evaluation of the administrative costs or savings related to identifying and enrolling children through ELE methods compared to the costs of identifying and enrolling eligible but unenrolled children through the state’s regular methods X   X   X X
2. An assessment of whether ELE improves a state’s ability to identify and enroll eligible but unenrolled children X X X X X X
3. Recommendations for legislative or administrative changes that would improve ELE’s effectiveness as a method for enrolling or retaining children in Medicaid or CHIP X X X X   X
4. A report on the percentage of children erroneously enrolled in Medicaid or CHIP based on the Express Lane agency findings       Xa   X

a The Final Report to Congress that is part of this evaluation will report ELE error rates, but these will not be calculated as part of the evaluation; per CMS’ instruction to states, states will report those to CMS, and we will report those in the Final report to Congress in 2013 if they are available in time to include them (Center for Medicaid and State Operations 2010).

CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services;

ELE = Express Lane Eligibility; SEDS = Statistical Enrollment Data System.


Table I.2 reviews the purpose of each of the four main study methods and the planned timing of each component. The first study component, the program cost, enrollment, and utilization study, aims to understand the administrative costs or savings in states that have implemented ELE, as well as a study of states that have implemented other simplifications (the “non-ELE” states). In the evaluation’s first year, we conducted a descriptive analysis of costs in the six states that had implemented ELE as of December 2010, and a descriptive analysis of enrollment in four of the six states (limited to those states that could identify those who had enrolled or renewed through ELE). The second study component, the analysis of SEDS data, uses state-reported data to assess ELE’s impact on enrollment. Both components will be assessed again in the study’s second year, with the descriptive study of costs and enrollment extended to all case study states (including non-ELE states) and a study of utilization differences in a subset of ELE states also occurring.


Table I.2. Methods Planned for Evaluation of ELE, Their Purpose, and Timing

Method Purpose Year 1 Year 2
Program Cost, Enrollment, and Utilization Study
  • Understand administrative costs or savings from ELE/non-ELE programs
  • Understand descriptive trends in new enrollment in ELE/non-ELE states
  • Assess whether utilization differs between ELE enrollees and those who enroll through traditional enrollment approaches in states where individual-level data with an indicator for ELE enrollment pathway are available
X X
Analysis of SEDS Data
  • Assess ELE’s effect on enrollment
X X
ELE and Non-ELE Case Studies, Including Key Informant Interviews and Focus Groups
  • Describe ELE implementation, evaluate its benefits, assess best practices in ELE states and in states that have adopted other simplification approaches (key informant interviews)
  • Hear family experiences about ELE and non-ELE simplification approaches (focus groups)
  X
Information Review, Quarterly Interviews, 51-State Survey
  • Provide comprehensive review of publicly available information on adopted simplifications (information review)
  • Provide periodic review focusing on state-specific sources and issues (quarterly interviews)
  • Internet survey with open- and closed-ended items about state simplifications and barriers and challenges to adopting ELE (51-state survey)
X X

ELE = Express Lane Eligibility; SEDS = Statistical Enrollment Data System.


Case studies will be conducted in 14 states: 9 states that had implemented ELE as of July 2012, and 5 non-ELE states that have implemented other enrollment or retention simplifications. These non-ELE case studies will be used to document, assess, and compare ELE with other approaches to identifying potentially eligible children and to streamline eligibility for Medicaid and CHIP. In addition, to gain lessons from states outside the 14 targeted for case studies, an informant from all the remaining states will be recruited for the quarterly monitoring calls, and Medicaid and CHIP directors in all states will be invited to participate in an online survey.9


8 This evaluation will report ELE error rates but will not calculate them; per CMS’ instruction to states, states will report those to CMS, and we will report those in the Final Report to Congress in 2013.

9 For a full description of the study methods, see Wrobel et al. (2012).

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