State officials overcame several challenges. ELE implementation required considerable time and patience from state staff– especially with two different agencies administering Medicaid and SNAP. States with a single agency administering both programs would probably have had an easier time implementing this ELE approach. State policymakers also noted that they may have been able to move more quickly if a single project manager had the authority to make final decisions once issues were thoroughly explored by the interagency team.
Roughly half of the children initially enrolled via ELE saw their Medicaid coverage terminate in November of 2010. Most terminations involved children who never used their cards and whose parents did not consent to enrollment at renewal. But among the children whose parents had consented to enrollment by using their card, at least 92 percent retained Medicaid.