Net administrative costs or savings differed widely across the six early states adopting ELE (Figure 1) (although these findings should be reviewed with caution given methodological challenges computing administrative costs and savings, including recall bias, incomplete data, and other process changes in the study period). For example, the ELE programs in Alabama and Louisiana yielded large net annual savings, driven by the staff time saved through processing large numbers of ELE applications and renewals in a more efficient manner than possible through traditional means. By contrast, in Maryland, ELE did not generate annual savings (for example, in staff time) that could offset new mailing costs associated with the policy, resulting in a net cost to the state from the policy. And, in New Jersey, targeted mailings cost the state about $250,000 per year, but no savings from ELE accrues to the state; any savings generated from more efficient ELE application processing are absorbed by a third-party administrator. Finally, ELE programs in Oregon and Iowa Medicaid were essentially “cost neutral” from an administrative perspective, as added mailing costs and the time spent processing unsuccessful ELE applications offset the time savings from processing successful ELE applications more efficiently than by traditional means.
Notably, in no case did program staff describe ELE as directly resulting in the need to hire additional staff or the ability to eliminate staff positions. Any time savings resulting from ELE were instead used to address other program needs. For example, Louisiana saved about 69,000 staff hours per year from ELE—the equivalent of 33 full-time positions—but it used the savings to make up for staffing reductions caused by state budget cuts. Staff described ELE as enabling Medicaid to stay on top of its workload in the face of reduced staffing. Similarly, Alabama noted that staff time saved through ELE may have enabled staff to process the traditional applications more quickly than would otherwise have been possible.
Table 3. Perceived Benefits of ELE for Applicants
|State Program Using ELE||Alabama Medicaid||Iowa Medicaid||Iowa Separate CHIP||Louisiana Medicaid||Maryland Medicaid||New Jersey Medicaid/CHIP||Oregon Medicaid/CHIP|
|Supporting Documentation Requested of Applicants Through ELE Method||Identity Citizenship Social Security Medical coverage (if applicable)||None||Medical coverage (if applicable)||None||Income Citizenship/ immigration status Social Security Expenses||None||Medical coverage (if applicable)|
|Supporting Documentation Requested of Applicants Through Standard Method||Identity Citizenship Social Security Medical coverage (if applicable)||Identity Income Citizenship Social Security||Identity Income Citizenship/immigration status Social Security Medical coverage (if applicable)||Income Citizenship/ immigration status Bank accounts Medical coverage (if applicable)||Income Citizenship/ immigration status Social Security Expenses||Income Citizenship/ immigration status Medical coverage (if applicable)||Income Citizenship/ immigration status (in some cases) Social Security Employment status Medical coverage (if applicable)|
|Time from Application Receipt to Coverage (Days) Through ELE Method||<6||2||5a||<1||No difference||7||3|
|Time from Application Receipt to Coverage (Days) Through Standard Method||<25||<30||20||<30||No difference||30||9|
|Interactions with the State||No difference||Fewer||Fewer||Fewer||No difference||Fewer||Fewer|
Source: Mathematica analysis of interviews with state staff. Information about documentation requirements reflects interviews with state staff supplemented by a review of Medicaid and CHIP websites and application materials.
a ELE enrollees to the separate CHIP program are enrolled roughly five days after the referral from Medicaid; however, coverage is retroactive to the Medicaid filing date.
CHIP = Children’s Health Insurance Program; ELE = Express Lane Eligibility.
Figure 1. Net Annual Administrative Savings and (Costs) from ELE
Source: Mathematica analysis of Interviews and follow-up correspondence with state staff between January and June 2012.
ELE = Express Lane Eligibility.