CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. 4. Discussion


Across the five state ELE programs examined here, the number of new enrollees associated with ELE varied widely. Results from Louisiana, which showed a substantial spike in ELE-related enrollments in the early months of the policy, suggest that using income determination findings from other agencies can, at least with the initial data match, potentially add a sizeable number of new children to coverage. In Iowa Medicaid and New Jersey, states that use partner agencies findings as a means to target application mailings, we find far fewer ELE-linked enrollments. These more tepid findings suggest that this outreach-focused approach to ELE, which requires parents to respond to mailings, may offer less promise as a means for enrolling large numbers of new children. However, as in Louisiana, we find that children enrolled via ELE in these states were older and, in the case of Iowa Medicaid, less likely to have had a recent spell of coverage than non-ELE children—suggesting that the policy may be picking up some children from families that are traditionally hard to reach.  

Alabama Medicaid’s and Iowa’s separate CHIP program both used ELE for a large proportion of the new enrollments they processed during the time period we examined. However, in Alabama there is no difference from the beneficiary’s viewpoint between entering through ELE or through the standard route (same forms, same documentation required).43 In Iowa’s separate CHIP program, ELE enrollees are drawn from families that applied to Medicaid. ELE does reduce the steps and paperwork required of applicants referred from Medicaid to the separate CHIP program, but it is not being used as a mechanism to target and enroll eligible but uninsured children. Although we do not have the evidence to verify this, it is likely that the children who enrolled through ELE might have enrolled anyway. Therefore, in these states the value of ELE may be mostly the administrative savings and efficiencies it creates.

Similarly, the findings on retention of ELE enrollees vary across states. When compared to non-ELE enrollees, ELE enrollees have higher rates of retention in Iowa Medicaid, lower rates of retention in Louisiana and Iowa’s separate CHIP program, and no difference in retention in Alabama. This is likely due to the design of these programs; for example, the low retention rate for ELE enrollees in Louisiana is almost certainly tied to the use of a temporary opt-out policy by the state. However, given the relatively short time since implementation of most of the programs, the question of retention under ELE will need to be revisited.

This initial descriptive analysis of ELE enrollments gives a sense of the impact of ELE on enrollment growth and which populations may particularly benefit from ELE. During the second year of the evaluation, we will update the analyses conducted in the first year using individual-level data for all six states. This will allow us to examine ELE’s impact on renewals in Alabama and Louisiana and observe longer-run trends in new enrollments and retention in all six states, including outcomes such as churning on and off public coverage that were not possible to document during the relatively short, first-year evaluation observation period.

43 This is true as long as the applicant does not report self-employment income that cannot be verified via other available databases.

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