As described in Chapter I, many new primary data collection activities are planned for the second evaluation year, including a 51-state survey investigating state simplifications and administrator views on ELE, case studies in ELE and non-ELE states including key informant interviews and focus groups, and a utilization analysis in a subset of ELE states where individual-level data are available. These data collection activities will help us interpret first-year findings, understand the longer-term effects of ELE on costs and enrollment, and shed light on new issues (such as whether utilization differs between those entering through ELE versus traditional routes). We are also eager to understand whether early findings about agency choice being less important than other factors persist in states that have partnered with agencies not yet studied, including the newly added ELE program in New Jersey (with NSLP) and Georgia’s ELE, which is partnering with WIC. Another important new contribution will be the qualitative assessment in non-ELE states, which will allow us to understand and compare alternative simplifications and their potential to contribute to administrative savings, enrollment or retention gains, or both, as well as whether the alternative simplifications might help states simplify adults’ enrollment in 2014. This qualitative assessment will also help us understand more about opportunity costs related to investment in simplification strategies besides ELE.
Key first-year activities will be continued in the second year. For example, we will continue to study administrative cost and enrollment outcomes linked to ELE to understand whether and how they change as ELE programs and processes mature. Another year’s worth of data will help us revisit our multivariate analysis and assess the extent to which ELE significantly increases Medicaid and CHIP enrollment. Where data are available, it will also help us investigate whether ELE continues to enroll relatively large numbers of older children, an eligible population that has been traditionally harder to reach than younger children. Similarly, we will update the SEDS analysis. By doing so, we can assess a much more substantial period of ELE performance in most states, enriching the statistical precision of the analysis and providing more detail on the effects of ELE, particularly those that might be lagged or time-limited. We will also use SEDS data on new Medicaid/CHIP enrollment to tease out ELE’s effect on the flow of new enrollees, provided the data quality is sufficiently improved. This could provide additional information related to the effects of ELE on new Medicaid/CHIP enrollment as opposed to retention, as well as lead to additional policy recommendations. For instance, if the ELE effect from this study is primarily driven by new enrollment but not retention, it’s possible that ELE’s impact on enrollment will decrease over time if it is associated with high levels of Medicaid/CHIP churning.
This collection of activities will inform two key deliverables: (1) recommendations on possible ELE improvements, at the state and Federal levels; and (2) a second Report to Congress. The recommendations report will focus on two topics central to maximizing ELE’s effectiveness: (1) administrative and legislative changes to improve ELE’s effectiveness; and (2) best outreach and streamlined enrollment/renewal practices under Medicaid and CHIP, whether through ELE or other simplifications. The audiences for these recommendations are Federal policymakers with the authority to reshape ELE, as well as Federal and state officials seeking guidance on how best to enroll eligible but uninsured children in Medicaid and CHIP.
Given the findings to date and the current policy environment, we anticipate that the recommendations also might include several other topics. For example, we discussed above the importance of considering lessons from ELE for Affordable Care Act implementation. As noted in Chapter I, we are also interested in understanding whether ELE might potentially alleviate churning issues. Moreover, because Federal lawmakers must decide whether to continue ELE’s statutory authority beyond FY 2013, we could identify the gains and risks of ending, continuing, or modifying this option. Included in that assessment would be a review of whether the evidence suggests that ELE is being used for fraudulent enrollment, based on the separate work to calculate ELE error rates, as well as our case studies; this was a concern voiced as ELE was being debated by Congress in authorizing CHIPRA, so it will be an important consideration in the policy recommendation on ELE’s continuation (Congressional Record 2009 [Grassley]; Leavitt 2007). Finally, because ELE might break down silos between public benefit programs, we could identify lessons learned about bridging program gaps through strategies like ELE. As the second-year research activities occur, we expect there also may be additional topics identified that could be included in the recommendations related to ELE.
The final Report to Congress, due in 2013, will synthesize the findings of all data collection and analysis activities from the evaluation’s first and second years, summarizing and incorporating themes that emerged across the different evaluation components.