CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. b. Separate CHIP Program


What later became Iowa’s separate CHIP’s ELE process was initially implemented in July 2004 to address concerns about delayed or incomplete applications that occurred when cases were referred between Medicaid and the state’s separate CHIP program, hawk-i. Prior to July 2004, case files for children who were income-ineligible for Medicaid were manually transferred to the separate CHIP program, and CHIP staff independently conducted another eligibility assessment using their own income calculation rules. Under the automated referral process that Iowa developed, children who are assessed for Medicaid eligibility (either at initial application or at redetermination) and found ineligible due to income are electronically referred to CHIP. CHIP staff then accept the Medicaid income finding, verify insurance status (usually without applicant involvement), and enroll the children in CHIP.12 Enhanced coordination between the two agencies helps ensure that children eligible for public coverage do not “fall through the cracks” and remain or become uninsured. CMS recognized this automated referral mechanism as an ELE process as of July 2010. From June 2009 through December 2011, more than 1,000 children a month have been enrolled in hawk-i through it.13

12 CHIP staff check to see whether records indicate that a child has private health insurance, and if the records do so indicate, applicants must provide evidence to the contrary.

13 For this study, we requested enrollment data from states for the period beginning one year prior to the ELE program effective date. Because CMS recognizes the effective date as July 1, 2010, we requested and present data on enrollments since June 2009.

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