By Donna Cohen Ross, Center on Budget and Policy Priorities

All in one night — February 11 — 10,484 eligible children were enrolled into Louisiana’s Medicaid program. 

Are you trying to imagine this? If so, you’re probably picturing mile-long lines of children winding through Baton Rouge, parents in tow, clutching packets of forms and documents.  A winter storm warning is in effect — so said the Baton Rouge newspaper that day — and freezing rain is already pelting the city, with an accumulation of 1 to 2 inches of snow expected overnight. The crowd of babies and toddlers, tweens and teens, and thousands of others are just waiting, waiting, waiting.  You’re thinking this is an ill-advised stunt.  Can’t be done.  Not even with every eligibility worker plugging away, all night, nonstop. Not even with every family equipped with every bit of paperwork in hand, exactly in order. No way. Your anxiety level is out of control just thinking about it.

If this is where your imagination has taken you, relax.  What really happened in Baton Rouge that night took place calmly and efficiently while those thousands of children, families and eligibility workers were fast asleep.  What really happened was that 10,484 children got enrolled in one fell swoop through a new CHIPRA option called Express Lane Eligibility.

All together, in one night … done!  And they did it using findings from the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program, to determine Medicaid eligibility.  Make no mistake, however.  Louisiana officials didn’t just snap their fingers. It took many months of careful planning and preparation — and coordination with the separate agency that administers SNAP in Louisiana — to be sure the process would substantially ease enrollment and at the same time preserve program integrity. 

Here’s how it worked: State officials started with the knowledge that children who qualify for SNAP are in families with income that meets the test for Medicaid, and a significant proportion are likely to be uninsured.  A file containing all children receiving SNAP benefits was transferred electronically from the computer system at the Department of Social Services to the computer system at the Department of Health and Hospitals, where Medicaid resides. Children already on Medicaid were removed.  The remaining file of children receiving SNAP but not Medicaid provided income findings, as determined based on food stamp rules, as well as the children’s Social Security numbers, residency and age.

Under Express Lane there is no need to recalculate income using Medicaid rules. So, these “borrowed” findings are used, along with other necessary information obtained from available data bases (such as U.S. citizenship from the Social Security data base) to determine Medicaid eligibility and enroll the children.

Next, Medicaid cards and decision notices were mailed to the families.  At that point, they were  informed that the last step in this process — affirming they want to enroll their child in Medicaid — would happen the first time they use the card to see a doctor or fill a prescription.

Ruth Kennedy, Louisiana’s Medicaid Deputy Director, explains the significance of the February 11th feat:  “Express Lane Eligibility is a huge administrative efficiency and takes advantage of 21st century technology. It demonstrates that we can reduce duplication of effort when government agencies work together.”  Ruth says that the state will be monitoring the system to refine the process and make sure that children enrolled through Express Lane are using their health care benefits — a sign that the new system really works.  Going forward, she anticipates that SNAP findings will be used to automatically enroll children in Medicaid when they are determined eligible for food assistance.  Isn’t this just the kind of coordination Secretary Sebelius and Secretary Vilsack were talking about when they joined together to celebrate the first anniversary of CHIPRA last month?  

So, are you still visualizing those 10,484 children standing in line with their families to gain access to health benefits?  Erase that image and instead picture them avoiding unnecessary ER visits, getting critical preventive care, medical treatment and the prescription medications they need.  Nice picture, huh?  Not bad for a night’s work!