Louisiana’s Department of Health and Hospitals, which administers Medicaid, chose the Department of Children and Family Services, which administers SNAP, as its Express Lane partner agency. The ELE program was initially implemented for new Medicaid enrollments. Officials first conducted a one-time data match between the two programs in December 2009 to identify families receiving SNAP but not Medicaid. SNAP families whose children were not enrolled in Medicaid received a letter informing them of their children’s eligibility for it and explaining how they could opt out. Children identified from the initial data match who did not opt out were automatically found eligible for Medicaid in February 2010. Their families were mailed a Medicaid card and a letter informing them that use of the card would constitute consent to the child’s enrollment in Medicaid. At the point of renewal, children who had never used the card and did not take advantage of a final opportunity to consent to enrollment were disenrolled, in keeping with CMS rules (Dorn et al. 2012).
Since initial implementation, ELE in Louisiana has undergone multiple adjustments. In November 2010, the program expanded to include redeterminations. In January 2011, the SNAP application form was changed to include a check box that allowed families to opt in to the data match and consent to enrollment into coverage. Relative to the prior opt-out procedure, this simplified the administrative process somewhat, because state officials did not need to monitor card usage to confirm consent to enrollment. Among children who opt in, those found eligible for and not already in Medicaid are automatically enrolled, and citizenship status is verified via the Social Security Administration.14 Data matches and enrollments are now processed daily, and Medicaid staff are not involved unless the Medicaid and SNAP information shows a mismatch (when a child has previously received Medicaid, the matching process sometimes flags a mismatched data element, such as date of birth).15 ELE renewals in Louisiana also happen automatically, without requiring staff time, using the same matching mechanism to establish income eligibility based on SNAP receipt at redetermination. Because ELE is fully automated, Louisiana’s process does not require beneficiaries to submit an application form or any documentation specifically for Medicaid. As of December 2011, more than 20,000 enrollments and 200,000 renewals had been processed via ELE.
14 According to the state, the citizenship status of a small number of children cannot be verified automatically, but this is usually resolved by correcting errors in information submitted to the Social Security Administration about the children to be checked.
15 When the data-matching process was first introduced and business rules for matching were being refined, more frequent intervention by staff was required to adjudicate potential duplicate enrollees. For example, if SNAP records showed a child who could not be found in prior Medicaid records, state staff manually intervened to ensure that, in fact, the records involved a new child rather than a duplicate enrollee (Dorn et al. 2012).