CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. b. Retention

12/01/2012

Alabama

In Alabama, retention rates for ELE new enrollments and non-ELE new enrollments appear similar. In both groups, 12-month continuous coverage rates are quite high, about 90 percent (Figure III.12). In addition to ELE, Alabama has enacted other enrollment and renewal simplification polices, such as 12-month continuous coverage and self-declaration of income, which apply to the vast majority of applicants. At 18 months, we likewise see similar rates of continuous coverage for both groups, about 70 percent of enrollees, suggesting little difference in the rate of successful redeterminations between the two groups.40


Figure III.12. Retention Rate: Months from New Enrollment, ELE Versus Non-ELE, Alabama Medicaid

Figure III.12. Retention Rate: Months from New Enrollment, ELE Versus Non-ELE, Alabama Medicaid

Source: Mathematica analysis of Maximizing Enrollment grantee state data, 2012.

ELE = Express Lane Eligibility


Iowa Medicaid

Children enrolling in Iowa’s Medicaid program through ELE have rates of retention that are similar to or slightly higher than those of non-ELE new enrollees (Figure III.13), starting with the 12-month measure. For example, approximately 68 percent of ELE enrollees remained continuously covered in the Medicaid program 13 months after their initial enrollment, compared to 61 percent of children enrolled through standard processes. The data show a similar 7-8 percentage point difference at 18-months; however the sample of ELE children with enough follow-up to assess retention at this time point is only 538 individuals, so these numbers should be interpreted with caution.


Figure III.13. Retention Rate: Months from New Enrollment, ELE Versus Non-ELE, Iowa Medicaid

Figure III.13. Retention Rate: Months from New Enrollment, ELE Versus Non-ELE, Iowa Medicaid

Source: Mathematica analysis of state-reported data, June 2009 — February 2012.

Note: Because the program began in June 2010, data are not yet available to present the 24-month retention rate statistics.

ELE = Express Lane Eligibility.


Iowa’s Separate CHIP Program

Figure III.14 shows retention rates in Iowa’s separate CHIP program for ELE and non-ELE enrollees. At each of the retention points examined, children enrolled via ELE were less likely to have remained continuously enrolled than children entering through the standard enrollment process. For example, at 12 months after initial enrollment, 68 percent of non-ELE enrollees are still enrolled in Iowa’s separate CHIP program compared to 55 percent for ELE enrollees. It is likely that this disparity in retention rates is due partly to cost-sharing requirements in the separate CHIP program; non-ELE enrollees are likely to expect cost-sharing requirements, but ELE enrollees are not, since they apply to Medicaid rather than to the separate CHIP program. Put differently, ELE children enter CHIP through Medicaid, whereas other children enter CHIP “off the street.” Those different routes into the program may be associated with characteristics that lead to different retention rates, such as frequently fluctuating household circumstances. It is not clear how much of the difference in retention is due to ELE, compared to these other factors.


Figure III.14. Retention Rate: Months from New Enrollment, ELE Versus Non-ELE, Iowa’s Separate CHIP Program

Figure III.14. Retention Rate: Months from New Enrollment, ELE Versus Non-ELE, Iowa’s Separate CHIP Program


Louisiana

ELE enrollees in Louisiana are less likely to remain enrolled as long as children who enroll through standard enrollment processes (Figure III.15). However, the difference is likely due to the state’s initial approach to ELE, which was an opt-out approach but required affirmative consent—which was the family’s use of Medicaid coverage. At renewal, children who had completed the enrollment process by using their Medicaid cards were renewed automatically if they continued to receive SNAP. By contrast, the children who had never consented to enrollment were terminated unless they took advantage of a final opportunity to consent, as part of the renewal process. Largely due to this approach, the initial cohort of ELE enrollees experienced high early attrition; of the 17,917 children enrolled via ELE under the “opt-out” policy, only 7,863 (less than 45 percent) remained continuously enrolled for 12 months.41 Louisiana has since changed its SNAP application form to allow an opt-in policy for data matching, replacing the two-step process described above. However, not enough time has elapsed since implementation to allow for a comparison of retention of children enrolling under this approach. We plan to update this analysis to address that question in the second year of the evaluation.


Figure III.15. Retention Rate: Months from New Enrollment, ELE Versus Non-ELE, Louisiana

Figure III.15. Retention Rate: Months from New Enrollment, ELE Versus Non-ELE, Louisiana

Source: Mathematica analysis of Maximizing Enrollment grantee state data, 2012.

ELE = Express Lane Eligibility.


40 Using regression models that exploit the individual-level data available in Alabama, we continue to see only small (2-4 percentage point) differences between the two groups in retention rates after controlling for possible differences in age, gender, and month of enrollment.

41 In regressions that control for age, gender, and month of enrollment, the differences in retention rates between ELE and non-ELE fall by about one-third, a result driven by the much older age distribution of ELE enrollees (discussed below).

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