Data on the administrative costs of ELE were primarily obtained through telephone consultations with state staff. Initial conversations were conducted between January and March 2012, following a structured discussion guide (found in Appendix A). From March through June 2012, we submitted notes from these discussions to state staff for review and verification, and we sought follow up to any questions that had not been resolved during the initial conversation. The discussion guide solicited detailed information on: the traditional enrollment process; the steps that are abbreviated, omitted, or added through the ELE process; the marginal costs associated with ELE and traditional enrollment processes; and the costs of initial ELE implementation. Cost domains that we considered included the salary and benefits of state staff; contractor reimbursements; modification of information management systems; and other direct costs, such as printing or mailing applications. We also sought to understand contextual factors that might affect estimates of costs, such as other concurrent changes in enrollment processes and prior data-sharing relationships with partner agencies that may have impacted the relative cost and ease of formalizing ELE data-sharing arrangements.
To assess changes to these cost domains, we sought information from policy, program, information systems, and front-line eligibility workers at state Medicaid and/or CHIP agencies. We also held brief discussions with ELE partner agency staff where possible. For Alabama and Louisiana, which have implemented ELE renewal processes, we explored both initial and renewal ELE processes, relative to the traditional processes. To supplement information obtained through discussions with state staff, we reviewed publicly available documents including state plan amendments, ELE and standard application forms, and state budget and performance reports.