CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. Ele Implementation Options for States


Section 203 of CHIPRA authorizes ELE and permits states to rely on findings of other public agencies to determine whether a child satisfies one or more requirements for Medicaid or CHIP eligibility. In doing so, states can disregard technical differences in how these programs define the household members whose earnings are considered in determining eligibility, as well as other methodological differences in assessing whether children meet applicable requirements (Dorn et al. 2012). ELE can be used to meet any eligibility criterion except U.S. citizenship.

Under the statute, states can choose to partner with any of 11 specific types of state agencies; states also can select an unlisted agency that fits the definition of an Express Lane agency; and if they choose, states can obtain and use information directly from state income tax records or returns (CHIPRA section 203; Center for Medicaid and State Operations 2010). With ELE, not only can the Express Lane agency vary, but so can ELE features. For example, states can apply ELE to CHIP and/or Medicaid, with a focus on enrollment, renewal, or both. states also can use traditional approaches to CHIP “screen and enroll requirements” or they can choose one of two alternative approaches for meeting these requirements. In addition, in pursuing ELE, states can choose to include or exclude an “automatic enrollment” option, possible when states have all the information they need from the Express Lane agency findings to make an eligibility determination or renew coverage, without the need for an application for coverage.

CHIPRA included several protections for families who might be subject to ELE. For example, Express Lane agencies must notify families that their information will be shared with the Medicaid or CHIP agencies, solely to determine Medicaid or CHIP eligibility, and families must be able to opt out of sharing this information (CHIPRA section 203). To use the automatic enrollment option, states must obtain the family’s consent to enroll the child, and the family must be informed about the available services, how to access them, if there is cost sharing, how to maintain the coverage, etc. In addition, for children subject to premiums or cost sharing (common in CHIP programs), the state must provide notice to the family that the child might qualify for lower premiums or cost sharing if the child were evaluated for eligibility using “regular” procedures (Center for Medicaid and State Operations 2010). ELE cannot be used to deny coverage; CHIPRA requires states to initiate a standard eligibility determination for Medicaid and CHIP for any child found ineligible through the use of ELE.

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