CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. a. New Enrollment

12/01/2012

Alabama

Alabama Medicaid began using SNAP and TANF databases to establish income on initial applications in April 2010. During the first 23 months of this policy, ELE was used to process 56,673 initial Medicaid applications. Use of ELE increased steadily during the first few months the program was in place, with the number of ELE enrollees increasing from fewer than 1,000 in April to 2,257 in July 2010.35 Starting in August 2010, use of ELE in the processing of initial enrollments appeared to reach a steady level, with the state averaging 2,588 ELE enrollments per month through December 2011. In the last two months for which we have data (January and February 2012) we note an uptick in ELE use, with approximately 3,500 ELE processed new enrollments in February 2012.

In the two years ELE has been used for initial applications, the number of children newly enrolling in Medicaid through standard processes has steadily declined (Figure III.7). New enrollments averaged approximately 13,500 per month in the 12 months before ELE, reached just over 15,000 in April 2010, the month ELE began, and then began to decline as ELE use picked up. Total new Medicaid enrollments have been flat or slightly declining over the period—averaging 13,651 per month in calendar year 2009, 13,518 in 2010, and 11,152 in 2011.


Figure III.7. New Medicaid Enrollment, ELE and Non-ELE, Alabama

Figure III.7. New Medicaid Enrollment, ELE and Non-ELE, Alabama

Source: Mathematica analysis of Maximizing Enrollment grantee state data, 2012.

ELE = Express Lane Eligibility.


Iowa Medicaid

ELE-generated new enrollments from Iowa Medicaid’s partnership with the state SNAP agency were modest over the first 21 months of the program. From June 2010 through February 2012, 2,333 children were newly enrolled in Iowa’s Medicaid program via ELE.36 Over the same period, 128,507 children were newly enrolled in Medicaid through standard enrollment processes (Figure III.8). As a percentage of overall new enrollments during this period, less than 2 percent of all new Medicaid enrollments occurred via ELE applications.


Figure III.8. New Medicaid and Medicaid Expansion CHIP Enrollment, ELE and Non-ELE, Iowa

Figure III.8. New Medicaid and Medicaid Expansion CHIP Enrollment, ELE and Non-ELE, Iowa


Iowa’s Separate CHIP Program

Iowa’s program of referring unsuccessful Medicaid applications to the separate CHIP program for auto-enrollment using Medicaid’s income eligibility findings has been in place since 2004, although our data start in June 2009.37 During the 31 months examined, Iowa’s automatic Medicaid to separate CHIP ELE referral program facilitated 33,472 new enrollments. During the same period, 40,590 new enrollments were processed using standard enrollment processes.

As a tool for enrolling children, ELE has been growing in importance for Iowa’s separate CHIP program during the period examined. In December 2011, 54 percent of all new enrollments were processed by Iowa separate CHIP program’s ELE component, up from 41 percent in June 2009, the first month for which we have data (Figure III.9). This trend may merely reflect growth in the share of children who are newly enrolling in the separate CHIP program as a result of a Medicaid transfer, regardless of the existence of an ELE policy. Thus, it can offer little information on whether ELE has affected the numbers of children covered by insurance in the state. However, given the number of applications processed using ELE during the period, there is strong evidence that ELE has been an important part of the separate CHIP program’s eligibility and enrollment system in Iowa.


Figure III.9. New Separate CHIP Program Enrollment, ELE and Non-ELE, Iowa

Figure III.9. New Separate CHIP Program Enrollment, ELE and Non-ELE, Iowa


Louisiana

Using ELE to auto-enroll eligible children based on determination from the state SNAP agency added 22,430 new enrollments in the Louisiana Medicaid program (which includes both Medicaid and the state’s Medicaid expansion CHIP program) from February 2010 to March 2012. As discussed in Chapter II, Louisiana’s ELE program has evolved during the period examined, and the trends in enrollments processed by ELE coincide with those changes.

The initial data match with SNAP coupled with a data match “opt-out” policy extended coverage to a substantial number of children in the state, as evidenced by the big spikes in new enrollment in the first half of 2010 (see Figure III.10): 16,993 children were newly enrolled in Medicaid via ELE between February 2010 and July 2010.38 Many of the children enrolling through ELE in the initial months of the policy remained in public coverage for only a short time. Nevertheless, this initial influx of new enrollees coincided with a shift in the intercept for total enrollment. Total enrollment in Medicaid and the state’s Medicaid expansion CHIP program increased from 646,963 in January 2010, the month prior to the first ELE enrollments, to 669,321 in January 2011 (data not shown).


Figure III.10. New Medicaid and Medicaid Expansion CHIP Enrollment, ELE and Non-ELE, Louisiana

Figure III.10. New Medicaid and Medicaid Expansion CHIP Enrollment, ELE and Non-ELE, Louisiana

Source: Mathematica analysis of Maximizing Enrollment grantee state data, 2012.

ELE = Express Lane Eligibility


In January 2011, Louisiana changed the SNAP application to allow families to opt in to ELE data sharing and enrollment. Additionally, in early 2011 the state moved from monthly to daily data matching across the two agencies. We find essentially no ELE-generated new enrollments from November 2010 through July 2011, as state officials reported that ELE was “turned off” while the state implemented these new policies.

In the subsequent eight months—from August 2011 to March 2012 (the last month for which we have new enrollments)—4,511 new enrollees entered via ELE. These figures suggest some continued new enrollment gains through the ELE mechanism, and give us some indication of the number of monthly new enrollees in SNAP that are found to be eligible for and not already enrolled in Medicaid and auto-enrolled through ELE (500 to 800 per month).

New Jersey

Overall, New Jersey’s ELE program has led to 5,321 children enrolling in Medicaid or CHIP via ELE processes. However, after an initial uptick in new enrollment via ELE in the months following implementation, New Jersey’s “in-reach” partnership with the state Division of Taxation has not led to meaningful numbers of children directly enrolling in Medicaid or CHIP through ELE.

During the first calendar year of the program, approximately 300,000 ELE applications were mailed to all households that checked the box on the tax form indicating that they had uninsured dependents. In response to this outreach, the data show new enrollment of 2,642 children via ELE in Medicaid and 1,762 via ELE in CHIP from June 2009 through December 2009 (see Figure III.11). In these initial seven months, approximately 8 percent of all new CHIP and Medicaid enrollments processed by the state’s vendor were ELE applications.39

In the subsequent two years, far fewer applications were mailed due to changes to the insurance question on the tax form and other screening guidelines about which families were eligible to receive a mailing. A likely consequence of these targeting decisions was that very few children were directly enrolled through the ELE pathway, according to the data. In calendar years 2010 and 2011, only 917 children were enrolled in Medicaid and CHIP via ELE. Further research will be needed to explore other potential causes for this drop in enrollment through ELE.


Figure III.11. New Medicaid and CHIP Enrollment, ELE and Non-ELE, New Jersey

Figure III.11. New Medicaid and CHIP Enrollment, ELE and Non-ELE, New Jersey

Source: Mathematica analysis of state-reported data, May 2008 – December 2011.

ELE = Express Lane Eligibility.


35 Based on the individual-level data, the first new ELE enrollments started in March 2010, likely due to retroactively applying a start date for some children who were enrolled in April.

36 This includes children eligible for either the state’s traditional Medicaid or the Medicaid expansion CHIP program. Of the 2,333 new enrollments processed by ELE, 2,141 of these children were eligible under Medicaid eligibility criteria and 192 were eligible under the Medicaid expansion.

37 Iowa’s separate CHIP program’s ELE process was officially recognized in June 2010, even though the state had this process in place since 2004. Given that there were no changes in policy when the program was recognized as ELE, we asked the state to provide data starting in June 2009 to match what we requested from Iowa Medicaid.

38 According to our conversations with state staff, the processing of individuals found eligible but not enrolled in Medicaid in the initial data match took place over several months. In particular, manual review was required to work through data mismatches between the two administrative databases—for example, when the two agencies had different Social Security numbers or dates of birth for the same individual.

39 As mentioned above, Medicaid enrollments processed by the counties are not included in this analysis.

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