Examples of Promising Practices for Integrating and Coordinating Eligibility, Enrollment and Retention: Human Services and Health Programs Under the Affordable Care Act. 1. Streamlining eligibility determination for one program based on datalinkages with other programs

07/01/2014

 
Location and Programs Practice Additional Resources
Alabama – Medicaid and SNAP The state implemented Express Lane Eligibility, qualifying children for Medicaid based on SNAP findings. Kaiser Commission on Medicaid and the Uninsured. 2012. Secrets to Success: An Analysis of Four States at the Forefront of the Nation’s Gains in Children’s Health Coverage. http://www.kff.org/medicaid/upload/8273.pdf
Iowa – SSA and Health Programs The state verifies citizenship for health programs using electronic data matches with SSA. This practice along with other initiatives has helped Iowa reduce the number of uninsured children by 19.4 percent between 2008 and 2010. Kaiser Commission on Medicaid and the Uninsured. 2012. Secrets to Success: An Analysis of Four States at the Forefront of the Nation’s Gains in Children’s Health Coverage. http://www.kff.org/medicaid/upload/8273.pdf
Massachusetts – Health Care Individuals were qualified for subsidies based on data matches with the state’s former free care program without having to complete applications. Approximately one out of every four newly insured individuals was found eligible due to data matches. Dorn, Stan and Elizabeth Lower-Basch. 2012. Moving to 21st- Century Public Benefits: Emerging Options, Great Promise, and Key Challenges. Kaiser Family Foundation. http://www.clasp.org/admin/site/publications/files/Moving-to- 21st-Century-Public-Benefits.pdf
Massachusetts – SNAP and Children’s Health Care Through an ELE waiver, the state uses SNAP findings to renew eligibility for both children and parents. Kaiser Commission on Medicaid and the Uninsured. 2012. Secrets to Success: An Analysis of Four States at the Forefront of the Nation’s Gains in Children’s Health Coverage. http://www.kff.org/medicaid/upload/8273.pdf
New Jersey – Low Income Home Energy Assistance Program (LIHEAP) and Medicare The state automatically provides LIHEAP to residents who qualify for the Medicare Part D Low-Income Subsidy (LIS). This program operates by means of data exchange among the LIHEAP program, the state’s Pharmaceutical Assistance to the Aged and Disabled (PAAD) program, and LIS. PAAD and LIS have income eligibility limits lower than for LIHEAP. Automatic enrollment raised the proportion of income-eligible elders enrolled in NJ’s LIHEAP, compared with other states. Dieterle, Jim. 2011. Automatic Enrollment of New Jersey’s Low-Income Elderly and Disabled Households Into LIHEAP, MJ’s Universal Service Fund Program, and SNAP Application Assistance. Presentation for the National Energy and Utility Affordability Conference. AARP. http://www.energyandutilityconference.org/Assets/2011%20Co nference/2011%20Presentations/3D_Jim%20Dieterle.pdf
New Jersey – SNAP and Medicare Building on New Jersey’s LIHEAP and Medicare Part D Automatic Enrollment, the state took advantage of the data matching potential with SNAP. County social services offices receive partially completed SNAP applications, on which they then follow up. Dieterle, Jim. 2011. Automatic Enrollment of New Jersey’s Low-Income Elderly and Disabled Households Into LIHEAP, MJ’s Universal Service Fund Program, and SNAP Application Assistance. Presentation for the National Energy and Utility Affordability Conference. AARP. http://www.energyandutilityconference.org/Assets/2011%20Co nference/2011%20Presentations/3D_Jim%20Dieterle.pdf
Oregon – SNAP and Medicaid The state implemented Express Lane Eligibility to use SNAP findings to establish children’s eligibility for Medicaid. The state’s Self-Sufficiency Modernization Project, an effort to provide online applications and automate eligibility decisions for all work supports programs, is ongoing. Kaiser Commission on Medicaid and the Uninsured. 2012. Secrets to Success: An Analysis of Four States at the Forefront of the Nation’s Gains in Children’s Health Coverage. http://www.kff.org/medicaid/upload/8273.pdf
National – Medicare, Medicaid, and SSI Medicare recipients who are identified through data matches as having received Medicaid or Supplemental Security Income in the previous year automatically qualify for Low-Income Subsidies for Medicare Part D prescription drug coverage. Stan Dorn and Elizabeth Lower-Basch. 2012. Moving to 21st-Century Public Benefits: Emerging Options, Great Promise, and Key Challenges. Kaiser Family Foundation. http://www.clasp.org/admin/site/publications/files/Moving-to-21st-Centur...
National – WIC and Medicaid WIC has used Medicaid participation to establish adjunct income eligibility since 1989. An individual is deemed adjunctively income eligible for participation in WIC if she or a qualifying family member (a pregnant woman or infant) is certified to receive Medicaid. Food and Nutrition Services (FNS).
http://www.fns.usda.gov/wic/howtoapply/eligibilityrequirements.htm; and 42 U.S.C. 1786, section 17(d)(2)(A).
National – NSLP and SNAP Direct certification in the National School Lunch Program (NSLP) automatically qualifies students for free school meals, based on receipt of SNAP or TANF benefits, without the need for parents or guardians to submit a NSLP application and without any requirement to determine NSLP eligibility on other grounds. Food and Nutrition Services (FNS). 2012. Direct Certification in the National School Lunch Program: State Implementation Progress School Year 2011-2012: Report to Congress. http://www.fns.usda.gov/ora/MENU/Published/CNP/FILES/DirectCert2012.pdf; and
National School Lunch Program: Direct Certification Continuous Improvement Plans Required by the Healthy, Hunger-Free Kids Act of 2010. Federal Register Vol. 78, No. 36. http://www.fns.usda.gov/cnd/governance/regulations/2013-02-22_AE10.pdf
Selected States – NSLP
and Medicaid
Pilot project to test direct certification in NSLP through which children automatically qualify for free school lunches based on Medicaid findings of income at or below 133 percent FPL, without any new NSLP application from parents and without any other eligibility determination by NSLP. Six states implementing as of 2012-2013. Example of Illinois implementation: Nutrition and Wellness Programs Division, Illinois State Board of Education. Electronic Direct Certification with Medicaid Demonstration Pilot – SY2013-2014 Update. May 21, 2013.
http://www.isbe.net/nutrition/dc-medicaid/edc-demo-pres052113.pdf
Vivian Lees and Patricia von Reyn, FNS. The Road to 95%: What’s Ahead for Direct Certification. December 6, 2012
http://www.schoolnutrition.org/uploadedFiles/Presentations/ANC_2012_-_De...
 

 

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