CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. I. the Federal Evaluation of Express Lane Eligibility


The Children’s Health Insurance Program (CHIP), a landmark initiative to help close the health insurance coverage gap for low-income children, celebrated its 15th anniversary in August 2012. Together with Medicaid, CHIP has helped fuel a decline in the number of uninsured children, which has fallen from 11.4 million (15.1 percent of children) in 1997 when CHIP was enacted to 8.0 million (10.0 percent of children) in 2010 (Current Population Survey, Annual Social and Economic Supplement 2011).

Initially authorized with bipartisan support through the Balanced Budget Act of 1997, CHIP was set to expire in 2007 unless reauthorized by Congress. Congress gave CHIP a temporary reprieve in December 2007: the Medicare, Medicaid, and SCHIP Extension Act of 2007 extended the program and funded it through March 2009 (Kaiser Commission on Medicaid and the Uninsured 2009). In February 2009, the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) reauthorized CHIP and funded it through 2013. Funding for CHIP was further extended to 2015 by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act).

Concerned about the many children eligible but not enrolled in public coverage—estimated at 4.7 million children as of 2008 (Kenney et al. 2010)—Congress provided states with new tools and new funds through CHIPRA to address shortfalls in enrollment, as well as in access to, and quality of, care (Harrington et al. 2011). One of these new options is a policy called Express Lane Eligibility (ELE). With ELE, a state’s Medicaid and/or CHIP program can rely on another agency’s eligibility findings to qualify children for public health coverage, despite their different methods of assessing income or otherwise determining eligibility. ELE thus gives states another way to try to identify, enroll, and retain children who are eligible for Medicaid or CHIP but who remain uninsured. The concept of using data from existing government databases and other means-tested programs to expedite and simplify enrollment in CHIP and Medicaid has been promoted for more than a decade; before CHIPRA, however, Federal law limited state reliance on information from other agencies by requiring such information to be cross-walked into the Medicaid and CHIP eligibility methodologies (Families USA 2010; The Children’s Partnership 2012).

Although the Affordable Care Act extended CHIP funding to 2015, CHIPRA slated the ELE policy option to end September 30, 2013, unless Congress acts to extend or modify it. Despite this possible end to the policy option, CHIPRA also gave states an incentive to adopt ELE by making it one of the eight policies states could adopt to qualify for performance bonus payments (CHIPRA section 104).1

1 Section 104 of CHIPRA specifies that the performance bonus money is intended to offset the additional costs resulting from enrollment and retention efforts. To qualify for CHIPRA performance bonuses, states must increase Medicaid enrollment beyond a specified target and implement at least five of eight administrative policies considered best practices for simplifying enrollment and renewal. See (2011) for more information on the bonus criteria.

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