CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. A. Analysis of Administrative Costs and Savings Associated with Express Lane Eligibility


Although Express Lane Eligibility (ELE) has significant potential to increase administrative efficiencies, the net effect of the policy on administrative costs is uncertain. On the one hand, using eligibility findings or other data from partner agencies may enable a state to lower per-enrollee costs by reducing the number of staff hours needed to process an ELE-based application or renewal. On the other hand, ELE may introduce new costs, both for public health insurance agencies and the agencies with which they partner, as the information systems required to support ELE are developed, built, and maintained. Depending on the design of their program, states may also incur new ongoing costs associated with outreach, such as mailing applications to individuals who report uninsured dependents on their state tax forms.

To evaluate the balance of costs and savings associated with establishing and continuing to operate ELE programs, we gathered data focused on two questions: (1) what are the up-front investment costs associated with implementing ELE? and (2) what are the marginal savings or costs to the state from processing an application or renewal using ELE, rather than the traditional mechanism? In addressing these questions, we considered the potential costs and savings not only for the state Medicaid and Children’s Health Insurance Program (CHIP) agencies, but also for their partner agencies.

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