Piloting new ways of doing things makes sense. It’s a way to test whether a concept or idea will work the way it’s envisioned, and fine-tune it based on actual experience. To this extent 13 states (AL, CO, GA, IA, LA, MD, ME, NJ, NY, OK, PA, SC, UT) have spent the past five years testing various implementations of express lane eligibility (ELE). ELE is a streamlined process that facilitates Medicaid or CHIP enrollment for children based on “verified” eligibility criteria from other public assistance programs, like SNAP. It was one of the new tools provided by the CHIP reauthorization in 2009 to facilitate enrollment and retention of children eligible for Medicaid and/or CHIP.
CHIPRA authorized a comprehensive, independent evaluation of ELE, which HHS recently released in this final report. I was pleased to be part of a technical advisory group that met with the program evaluators over the past few years and served as a sounding board on the evaluation process and findings. Now that the report is out, I’m happy to provide some cliff notes for those of you who don’t have time to read the 174-page report, although the 12-page executive summary is worth the read.
So let’s cut to the chase:
- ELE adoption can increase enrollment but the way in which states adopt it produces different outcomes. In particular, states found higher success in selecting ELE partners that have the ability to share data electronically.
- Automatic ELE processes serve the most individuals, yield the greatest administrative savings, and eliminate procedural barriers to coverage. On the other hand, little administrative savings and more modest enrollment increases are seen if families have to initiate or return an application for coverage.
- Most importantly, using ELE for renewals holds the greatest promise for administrative savings and keeping kids covered.
- Interestingly, the evidence suggests that ELE enrollees use fewer care health services than those enrolled, which is consistent with the theory that children eligible but not enrolled in public programs may simply be healthier.
I was particularly intrigued by the results in my birth state of South Carolina. The state implemented ELE using SNAP/TANF data for renewals starting in July 2011, and expanded to new enrollments in September 2012. By June 2013, the state renewed coverage for 276,622 children and enrolled approximately 92,000 new children. It’s good enough for me that nearly 400,000 children have gained or retained health coverage in South Carolina, but the news gets even better. The state estimates an annual cost savings of $1.6 million, much of it due to an automated process that has freed eligibility workers to work on other eligibility process improvements and get their new MAGI-based Medicaid system ready for 2014.
Unfortunately, ELE is at risk. When authorized ELE was attached with a sunset clause that has been extended until September 2014. And yet, there is clear evidence that ELE is an effective tool for states to connect kids to coverage and save money doing so. Notably, the investment that states have made in automating their ELE processes, which have proven to be the most effective use of ELE, will be lost if the policy option is not extended. For example, South Carolina estimates a total cost of $538,000 to implement its highly automated process.
Regardless of one’s political persuasion, we all agree that government should be efficient and effective. To this extent, ELE provides one more tool for state government to sharpen its efficiency and effectiveness, although tweaks to the policy may be in order based on the innovative piloting work done by the 13 states. Nonetheless, it should be made a permanent option for states to use to enroll and renew not only children, but also parents and other adults, to leverage the state’s investment in ELE and make government work smarter, not harder.