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


Louisiana’s use of ELE increased children’s Medicaid enrollment. During 2010, approximately 18,000 previously uninsured children joined Medicaid due to ELE. This represented a 3 percent increase in total children’s enrollment in Medicaid and CHIP, with ELE accounting for 28 percent of all new enrollees between February and July 2010. By November 2012, the total number of children enrolled through ELE reached 27,347.9

According to a state survey, the percentage of Medicaid-eligible children who lacked coverage fell from 5.3 percent in 2009 to 2.9 percent in 2011—the period that overlapped with ELE implementation.10 At that time, state officials did not implement any other policies that sought to increase participation among eligible children, and the percentage of uninsured increased among all other groups of low-income residents.11 As a result, state officials believe that ELE was responsible for these gains in children’s enrollment. Such gains were confirmed by the observations of community outreach groups as well as the different characteristics of ELE children compared to other Medicaid children. For example, in Louisiana, children age 7 or older are 22 percent more likely to be uninsured than are younger children. Yet 74 percent of ELE children were age 7 or older, compared to 57 percent of other Medicaid children.12

Enough time has passed to analyze the utilization levels that resulted from this streamlined enrollment method. A regression-adjusted model estimated that, during their first 12 months of coverage, 83 percent of children who auto-enrolled in Medicaid through ELE obtained services, compared to 88 percent of children who enrolled through non-ELE methods in Louisiana.13

Auto-enrolled ELE children in Louisiana were almost as likely to obtain some services as other children, but among the children who received care, ELE enrollees tended to use fewer services. For children who used any health care, regression-adjusted average costs for ELE children during their first 12 months were just 48 percent of the average amount for similar Louisiana children who enrolled using other methods.

Once the state changed its enrollment method to require parents to check an opt-in box on the SNAP application form, the average number of children enrolled via ELE as a result of monthly SNAP applications fell by 62 percent.14 This change did not result in a population more likely to use some rather than no services, however. The above-described regression-adjusted model estimated that, during their first 12 months of enrollment under the new “opt-in” check-box approach, 75 percent of ELE children used any services, compared to 83 percent who enrolled during the “consent through card use” method, and 88 percent who enrolled through non-ELE methods.15

As noted earlier, Louisiana’s use of ELE to renew children’s Medicaid coverage whenever all members of a Medicaid-enrolled household received SNAP allowed a substantial automation of renewals, with a small but statistically significant increase in the number of children receiving continuous coverage. Altogether, approximately 330,000 children had their Medicaid coverage renewed via ELE between November 2010 and November 2012. Primarily by automating the ongoing renewal of a sizable portion of the state’s Medicaid caseload, the state achieved roughly $1 million in net, annual administrative savings.

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