CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. States have implemented diverse ELE programs.

12/01/2012

As of April 1, 2012, CMS had approved nine states (Alabama, Colorado, Georgia, Iowa, Louisiana, Maryland, New Jersey, Oregon, and South Carolina) to implement ELE. Five of the states (Alabama, Colorado, Louisiana, Maryland, and South Carolina) are approved for ELE in their Medicaid programs, while four (Georgia, Iowa, New Jersey, and Oregon) are approved for ELE in both Medicaid and their separate CHIP programs. Even among this small number of states, the striking variation in ELE designs reflects the flexibility that CHIPRA afforded. For example, states’ partner agencies range from those administering other public benefits—such as the National School Lunch Program (NSLP) (New Jersey and Colorado), SNAP (Alabama, Iowa, Louisiana, Oregon, and South Carolina), Temporary Assistance for Needy Families (TANF) (Alabama and South Carolina), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (Georgia)—to those responsible for aspects of state revenue, including the Division of Taxation (New Jersey) and the Office of the Comptroller (Maryland). Tables 1 and 2 summarize the key features and aims of the ELE programs in the six states included in the descriptive analysis of the costs and new enrollment associated with ELE implementation.  


Table 1. Features and Implementation Status in Six States with Approved ELE Programs as of December 2010

State Program Using ELE Alabama Medicaid Iowa Medicaid Iowa Separate CHIP Louisiana Medicaid Maryland Medicaid New Jersey Medicaid/CHIP Oregon Medicaid/CHIP
Partner Agency SNAP and TANF SNAP Medicaid SNAP State tax agency State tax agencya SNAPb
Program Strategy SNAP and TANF income findings used to establish income after consumer declarations at application and renewal. Data match to identify potentially eligible children; shortened application form mailed out; SNAP findings establish income eligibility. Medicaid applications and redeterminations showing CHIP-level income automatically referred to CHIP for processing using Medicaid eligibility findings. Automated eligibility, enrollment, and renewal based on SNAP findings. Potentially eligible children identified; shortened application form mailed out. State income tax returns used in process to establish state residence. Data match to identify potentially eligible children; shortened application form mailed out. State income tax returns establish income eligibility. Data match to identify potentially eligible children; shortened application form mailed out. SNAP findings establish income eligibility.
Prior Data Sharing with Partner Agency X X X X   X X
State Plan Amendment Approval Date: Applications Jun-10 Jun-10 Jun-11 Jan-10 Sep-10 Jun-09 Oct-10
Implemented for Applicationsc Apr-10 Jun-10 Jul-04 Feb-10 Sep-08 May-09 Aug-10
State Plan Amendment Approval Date: Renewals Nov-09   d Jan-10      
Implemented for Renewalsc Oct-09   d Nov-10      
Implementation Status as of December 2011 Partial Full Full Full Partial Full Full
Enrollments as of December 2011e 50,257 2,065 33,427f 20,240 Unknown 5,321 4,632g
Renewals as of December 2011e 150,000     200,000      

Source: Mathematica interviews with state staff conducted between January and May 2012 and analysis of state administrative data provided by states between January and June 2012.

a New Jersey also has an NSLP ELE program, which has been implemented in all counties as of October 2011. Because it was not in place as of December 2010, the NSLP partnership is excluded from this initial analysis.

b As of December 2011, Oregon was also piloting an NSLP ELE program in four school districts.

c Implementation dates are those recognized by CMS as the program’s “Effective Date” unless available information suggests that a different date more accurately reflects the timing of meaningful changes. Implementation dates for Alabama, Iowa Medicaid, New Jersey, and Oregon are the CMS effective dates. The date for Iowa CHIP was given by state staff in an interview. For Louisiana, the date reflects when children were first enrolled via ELE. For Maryland, the 2008 date reflects the first outreach mailings on the basis of tax return information, which is the event considered by state staff to be the start of ELE in that state; this date also is referenced in Idala et al. (2011). Maryland’s process was not recognized as ELE by CMS until 2010, when the state started using the mailing process to establish in-state residency.

d Iowa’s separate CHIP ELE process does not include renewals. However, children whose eligibility is redetermined by Medicaid, resulting in an ineligibility finding, may be ELE-referred to CHIP, with income-eligibility for CHIP established based on Medicaid’s income findings. This constitutes an ELE transfer, rather than a renewal.

e Enrollment counts were computed from state administrative data and reflect the number of enrollments resulting from ELE application processes. Renewal counts reflect estimates provided by state staff during interviews of the approximate number of renewals resulting from ELE renewal processes.

f We requested enrollment data from states for the period beginning one year prior to the ELE program effective date. Because CMS recognizes the effective date for Iowa CHIP’s ELE process as June 2010, we present data on enrollments from June 2009 through December 2011. The number of enrollees since the ELE process began in 2004 is likely much higher.

g As of November 2011.

CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; ELE = Express Lane Eligibility; NSLP = National School Lunch Program; SNAP = Supplemental Nutrition Assistance Program; TANF = Temporary Assistance for Needy Families.

 


Table 2. Aims of ELE in Six States with Approved ELE Programs as of December 2010

State Program Using ELE Alabama Medicaid Iowa Medicaid Iowa Separate CHIP Louisiana Medicaid Maryland Medicaid New Jersey Medicaid/CHIP Oregon Medicaid/CHIP
Reduce staff time X X X X   X X
Improve outreach   X   X X X X
Simplify application experience a X X X X X X
Simplify renewal a     X      
Smooth transitions between Medicaid and CHIP     X        

Source: Mathematica interviews with state staff conducted between January and May 2012.

a Since April 2010, self-declaration of income has been accepted for most ELE and non-ELE children, if income cannot be verified through databases accessible to state eligibility staff. This is not the case for children of self-employed parents, for whom income verification is required. Thus, ELE reduces the documentation burden for children with self-employed parents whose income cannot be verified via other databases but can be verified via SNAP or TANF databases.

CHIP = Children’s Health Insurance Program; ELE = Express Lane Eligibility; SNAP = Supplemental Nutrition Assistance Program; TANF = Temporary Assistance for Needy Families.

View full report

Preview
Download

"rpt.pdf" (pdf, 1.1Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®