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


A state practice that has gained much attention in discussions of integration and streamlining the enrollment processes of health and human services programs is ELE, discussed briefly above in connection with Louisiana’s renewal of children’s health coverage. A new option created by CHIPRA, ELE permits states to provide children with Medicaid or CHIP based on findings from other public agencies. Even if the other agency uses a methodology for determining eligibility—such as household definitions and income disregards—that differs from Medicaid and CHIP methodologies, the other agency’s findings can be used to qualify children for health coverage. This eliminates the need for the health program’s case workers to “cross-walk” information from the other agency’s case files to see how it fits into the slightly different rules used for health coverage. It also means that families are not required to provide additional information that may be needed to address minor differences in program rules.

“Deemed” eligibility, comparable to ELE, has long been used by many different programs across the country, which apply different names to the same basic concept. For example, pregnant women and infants automatically qualify as “adjunctively eligible” for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) based on their receipt of Medicaid; children are “direct certified” as eligible for the National School Lunch Program (NSLP) based on their receipt of SNAP or Temporary Assistance for Needy Families (TANF); and through “categorical eligibility,” SNAP eligibility extends automatically to households in which every member receives Supplemental Security Income (SSI), TANF, or other cash assistance.

One option available to states implementing ELE is automatic enrollment, through which children can receive health coverage without filing standard Medicaid applications. Louisiana was the first state in the country to implement ELE auto-enrollment, and the second to implement ELE in any form. The Louisiana Department of Health and Hospitals (DHH) worked with the Department of Child and Family Services (DCFS), which administers SNAP, to implement an enrollment and renewal process that qualifies children as financially eligible for Medicaid based on data matches showing SNAP receipt.

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