The ELE option is intended to simplify the identification, enrollment, and retention of uninsured children eligible for Medicaid or CHIP. In turn, this simplification process may produce gains in coverage, as families who might otherwise not apply for (or renew) coverage for their eligible children, or might not complete this process successfully, are able to do so.
Although prior research on ELE’s possible coverage effects is limited, the available evidence supports the potential of the policy to produce meaningful gains in coverage. For example, using ELE to qualify children for health coverage based on their participation in SNAP, Kenney et al. (2010) estimate that ELE could reach 15.4 percent of eligible, uninsured children. Using ELE to qualify children for health coverage based on state income tax records could reach even more children: an estimated 89 percent of uninsured children who qualify for Medicaid or CHIP live in families who file Federal income tax returns (Dorn 2009). Presumably, a large proportion of these families file state tax returns as well, particularly in states that supplement the Federal Earned Income Tax Credit. A recently published descriptive analysis of the ELE program in Louisiana reported that state officials attribute the decline in the percentage of uninsured children who qualified for Medicaid from 5.3 percent in 2009 to 2.9 percent in 2011 to the state’s ELE policy, implemented in February 2010 (Dorn et al. 2012).
Research on other administrative simplification policies likewise offers evidence on the potential of ELE to produce coverage gains. For example, Bansak and Raphael (2006) used a pre-post design on the 1998 and 2002 March Current Population Surveys (CPS) and found that policy changes aimed at making it easier for families to enroll and retain coverage for their children (such as eliminating the asset test, offering continuous eligibility and coverage, and simplifying the application and renewal processes) had large, statistically significant positive effect on CHIP take-up. Similarly, Kronebusch and Elbel (2004) analyzed the CPS and found that certain administrative simplification policies, such as presumptive eligibility and self-declaration of income, had a positive effect on Medicaid and CHIP enrollment (although these findings have to be considered cautiously because of methodological limitations associated with estimating enrollment rates using a survey sample). In addition, Wolfe and Scrivner (2005) obtained similar results and also found evidence suggesting that specific outreach activities (such as dedicating a telephone line to help people complete applications and using community groups to do outreach and application assistance) can have a positive effect on CHIP take-up. In a more targeted and econometrically rigorous analysis, Aizer (2003) examined the impact of community-based application assistance programs in California on Medicaid enrollment using data from 1996 to 2000; like ELE, application assistance programs can lower the cost of enrollment from the family’s perspective. Overall, Aizer found that application assistance programs had a large impact on Medicaid enrollment, particularly among Hispanic (4.6 percent) and Asian (6 percent) children relative to other children in the same community.