CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. H. Concluding Thoughts

12/01/2012

  1. Are there other aspects of your ELE program that we should know about to understand how financial and staff time costs differ under ELE?
  2. Do you anticipate any changes to the cost of ELE in the next year? For example, because fixed-price contracts will be renegotiated to accommodate changes in work flow, because new staff will need to be hired, or because some aspects of ELE will become newly automated?
  3. Are there additional staff members within your agency with whom we should follow up for additional detail on any of the topics we have discussed?

Appendix Table A.1. Estimated Implementation Costs of ELE

State Program Using ELE Alabama Iowa Medicaid Iowa CHIP Louisiana Maryland New Jersey Oregon
Labor Costs to the State for Programminga $6,300 $84,000 $15,000 $106,000 Not available $40,000 $1,600
Number of Staff Trained 250 650 600 350 55 15b 60
Length of Training 2 hours 20 minutes 1 hour 2 hours 1 hour 4 hours 2 hours
Other Tangible Costs None Shorter application form developed
Cost: unknown
None Up to 10 program staff worked to resolve technical problems for six months
Cost: 310,000
Shorter application form developed Cost: unknown Shorter application form developed
Tax filing instructions changed Cost: unknown
Shorter application form developed
Cost: $2,050
Opportunity Costs None Staff diverted from other projects Not availablec Staff diverted from other projects Noned None None
Labor Costs to the State for Programming


Labor Costs to the State for Programming

State Program Using ELELabor Costs to the State for Programming ($)
Alabama6300
Iowa Medicaid84000
Iowa CHIP15000
Louisiana106000
New Jersey40000
Oregon1600
Number of Staff Trained


Number of Staff Trained

State Program Using ELENumber of Staff Trained
Alabama250
Iowa Medicaid650
Iowa CHIP600
Louisiana350
Maryland55
New Jersey15
Oregon60
Length of Training


State Program Using ELELength of Training (minutes)
Alabama120
Iowa Medicaid20
Iowa CHIP60
Louisiana120
Maryland60
New Jersey240
Oregon120

 

Source: Number of staff trained for Iowa CHIP was obtained from the Iowa Department of Human Services’ “Performance Report, Fiscal Year 2004,” February 16, 2005. All other data are from interviews and follow-up correspondence with state staff between January and June 2012.

a No states introduced new hardware to implement ELE.

b New Jersey also educated external tax preparers, such as Volunteer Income Tax Assistance preparers and tax-preparation companies such as H&R Block, on answering the new tax form question appropriately. Low-income tax preparers received about 15 minutes of training per person. Tax-preparation companies primarily received guidance through an update to the state’s tax-preparation guidance booklet.

c Information is not available due to the time elapsed since ELE was introduced. Iowa CHIP’s automated referral process has been in place since 2004.

d Although Maryland Medicaid reported zero opportunity costs, opportunity costs to the Maryland ELE partner agency are unknown because it did not participate in the first year of this evaluation.

CHIP = Children’s Health Insurance Program; ELE = Express Lane Eligibility.


Appendix Table A.2. Estimated Ongoing (Variable) Savings and Costs of ELE for Initial Applications and Renewals, Compared to Traditional Processing Routes

State Program Using ELE Alabama Medicaid Iowa Medicaid Iowa CHIP Louisiana Medicaid Maryland Medicaid New Jersey Medicaid/ CHIP Oregon Medicaid/CHIP
Time Savings (Minutes per Application) <5 28 a 31 None 22 16
Time Savings (Dollars per Application) 1 16 Not available 15 0 0b 8
Time Savings (from Applications, Dollars per Year)c $25,000 $20,000 Not available $163,000 $0 $0 $29,000
Time Savings (Minutes per Renewal) <5 N/A N/A 21 N/A N/A N/A
Time Savings (Dollars per Renewal) $1 N/A N/A $10 N/A N/A N/A
Time Savings (from Renewals, Dollars per Year) $60,000 N/A N/A $1,803,000 N/A N/A N/A
New Ongoing Costs (Dollars per Year) 0 13,000 Not available 0 75,000 251,000d 33,000
Net Annualized (Costs) or Savings $85,000 $7,000 Not available $1,966,000 ($75,000) ($251,000) ($5,000)

Source: Interviews and follow-up correspondence with state staff between January and June 2012.

Note: States marked N/A (not applicable) did not use ELE for renewals.

a Time savings compared to the pre-ELE Medicaid-to-CHIP referral process were not available. Consequently, the dollars saved per application, dollars saved per year, and net costs or savings cannot be calculated.

bTime savings for New Jersey accrue to eligibility processing contractors. New Jersey has not revised the contract with its third-party eligibility processor to account for ELE.

c Time savings are based on the average number of applications per month for the time the program has been in place.

d Based on the average number of mailings in the first three years of the program. Far fewer mailings have been sent out in more recent years. The most recent mailings in 2011 cost $75,000.

CHIP = Children’s Health Insurance Program; ELE = Express Lane Eligibility; N/A = not applicable.

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