Examples of Promising Practices for Integrating and Coordinating Eligibility, Enrollment and Retention: Human Services and Health Programs Under the Affordable Care Act. Description

07/21/2014

Louisiana’s approach to renewal is part of the state’s broader approach to streamlined eligibility determination for children’s Medicaid and CHIP, which encompasses initial applications as well as renewal. That includes such measures as 12-month continuous eligibility; electronic case files; an integrated application and renewal process that combines Medicaid and CHIP; the absence of any asset tests; in-person interviews at the family’s option, rather than as a state requirement; electronic signatures; business process reengineering in social services offices; and the use of a “reasonable certainty” standard in determining eligibility.

At the same time, the state has compiled a track record of accuracy well above the national average in determining eligibility. Louisiana’s most recent federal payment error review, for example, found an eligibility error rate of 0.3 percent—less than one-tenth the national average.2 Put simply, Louisiana is a national leader in both streamlining eligibility determination and safeguarding program integrity.

With that as context, Louisiana’s approach to renewing children’s Medicaid and CHIP coverage begins by seeing whether available data establish a reasonable certainty of continued eligibility. For the vast majority of children in these programs—90 percent of Medicaid children and 84 percent of those receiving CHIP3—data matches allow continued coverage without families needing to provide any information. The state applies three steps in sequence:

  1. Administrative Renewal: The state’s eligibility system checks to see whether the child falls into a category where Administrative Renewal applies. In such cases, certain household characteristics, based on prior data mining of administrative records, make continued eligibility virtually certain. Examples include a child in a household with income that consists entirely of Social Security; a child whose caretaker’s income is excluded for purposes of determining eligibility; a child with a single parent whose income consists entirely of child support; and a child who has qualified for Medicaid or CHIP for at least three years and who lives in a household with income of less than $500 per month. In such cases, the state sends a notice of renewal that requires households to provide information about relevant changes in household circumstances. If households do not respond, coverage continues. Caseworkers are not involved, unless families report changed circumstances.
  2. Express Lane Eligibility (ELE): If a child cannot be renewed administratively, ELE may apply. When a data match shows that a Medicaid household consists entirely of children who receive SNAP benefits, all members of the household are automatically renewed via ELE, without any need for manual intervention by caseworkers or any requirement for families to report changes in household circumstances.
  3. “Ex Parte” Reviews: Unlike the above two steps, this one requires manual action by caseworkers. If a child cannot be renewed using Express Lane or Administrative Renewal procedures, caseworkers see whether “Ex Parte” renewal is possible. “Ex Parte” is a Latin phrase indicating that action is taken by one party without involvement from the other. In this context, caseworkers investigate available data sources to see whether a child’s eligibility can be established with reasonable certainty, based on a combination of SNAP and TANF records, wage and unemployment insurance information, eligibility and payment data for Social Security and SSI, private vendor information, child support enforcement agencies, and other records. Before implementing ELE, the state renewed about half of Medicaid and one-third of CHIP cases using ex parte review, which eliminates the need for families to provide information before their children’s coverage continues.

If the state is unable to renew a child’s eligibility using any of these three methods, the state seeks to obtain additional information by phone. Only if all else fails does the state send renewal forms to families, seeking written information to redetermine eligibility.

Louisiana has also implemented other policies to streamline renewals. Paper signatures are not required to renew eligibility. Families can renew their children’s coverage at any time, outside normally scheduled renewal dates. For example, even if a child is in the middle of a 12-month coverage period, a new period can immediately begin when another program gathers information that demonstrates income at Medicaid levels, or when a family contacts the Medicaid agency for a different reason and the agency learns that the child continues to qualify. Moreover, Louisiana does not require financial verification if income is believed to be at least 25 percent below the maximum level permitted for Medicaid eligibility.

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