Most ELE programs incur new ongoing costs (Figure III.5). For example, ELE programs for Iowa Medicaid, Maryland, New Jersey, and Oregon include mailings to potential ELE enrollees that would otherwise not be sent.26 These mailings cost the public sector approximately $12,000 per year for Iowa, $24,000 per year for Oregon, $75,000 per year for Maryland, and $251,000 per year for New Jersey.27, 28 Data available for Iowa suggest the response rate for this mailing is about 10 percent. Given the rate at which mailings are successfully converted to enrollments, mailing costs per ELE enrollment ranged from $6 for Oregon and $9 for Iowa Medicaid to $122 for New Jersey (data for Maryland were not available).
Figure III.4. Value of Time Saved from Processing ELE Applications and Renewals, Per Year
Source: Mathematica analysis of Interviews and follow-up correspondence with state staff between January and June 2012.
Notes: Maryland’s current ELE process saves no time compared to the traditional application. For New Jersey, the value of time savings accrues to the third-party contractor, since contracts were not revised to account for ELE. Thus, savings to the public sector are shown here as zero. As explained earlier in the chapter, these estimates assume no impact on total enrollment—any increase in enrollment that might be caused by ELE would result in reduced time savings, meaning the total administrative savings would be overstated here.
ELE = Express Lane Eligibility.
In Oregon and Iowa Medicaid, ELE also results in time being spent on unsuccessful ELE applications, which cost staff time that would not be spent if applications were submitted only through the traditional route. For Oregon, around 23 percent of ELE applications do not result in enrollments, and for Iowa Medicaid around 11 percent of ELE applications do not result in enrollments. The time spent on these unsuccessful applications costs about $8 per application in Oregon and about $7 per application for Iowa Medicaid, resulting in annual costs of $9,000 and $1,000 respectively.
Figure III.5. New Ongoing Costs Associated with ELE, Per Year
26 In some states, outreach mailings that are associated with ELE would probably have been sent even if ELE had not been implemented. For example, in Maryland, tax outreach mailings were done before the process evolved into ELE in 2010. However, since mailings are an intrinsic part of ELE in these states, and since we do not know the extent to which mailings would or would not have happened without ELE, we have included the costs of all ELE mailings in our estimates of ELE costs.
27 For Iowa Medicaid and Maryland, regular mailing costs include printing, materials, and postage. For New Jersey, regular mailing costs include printing, materials, postage, and mailing assembly. For Oregon, regular mailing costs include printing, materials, postage, and staff time, including programming. Maryland’s partner agency may also incur monthly staff costs; however, the Office of the Comptroller did not participate in the first year of this evaluation, so these data are unavailable.
28 The number of ELE packets that New Jersey mails out has steadily declined over time. The estimates of $251,000 per year and $122 per successful application reflect the average since program implementation. In 2009, 300,000 packets were mailed, but in 2011 only 41,000 packets were sent. Thus, by 2011 ELE mailing costs had declined to $76,000 per year. However, since response rates in 2011 were lower than in 2009, the mailing cost per successful ELE enrollment was actually higher by 2011, at $150 per successful ELE enrollment.