States Could Lose Cost-Effective Express Lane Eligibility if Congress Fails to extend CHIP Promptly

When CHIP was reauthorized in 2009, it provided a new tool – known as Express Lane Eligibility (ELE) – for states to enroll and renew children’s coverage. ELE allows states the flexibility to use findings from other public programs, like SNAP, to determine eligibility for Medicaid or CHIP. ELE can be used at enrollment, renewal, or both.

It reduces the paperwork burden for states and families, using documented evidence of key eligibility criteria such as income or residency. Once a family has provided information, and the state has verified it for other programs such as the Supplemental Nutrition Assistance Program (SNAP), then Medicaid or CHIP can use that data to verify eligibility for health coverage.

Unlike almost all CHIP provisions, which continue even if Congress fails to extend CHIP and the state runs out of carryover funds, ELE has an explicit sunset date. Initially, ELE was authorized through CHIPRA until September 2009. But when CHIP was extended through the ACA and then MACRA, ELE was also extended. But just like the current funding for CHIP, ELE expires on September 30, 2017.

What does this mean for states? Technically speaking, they are not authorized to use ELE starting on October 1, 2017. But it’s not that simple. Some states, like Louisiana, have invested significant resources in automating the exchange of information between Medicaid/CHIP and the human services agency that administers SNAP. Making changes to these systems takes time and resources: two commodities in short supply as we face the expiration of CHIP funding.

It would be is shortsighted for policymakers to think there’s no urgency in taking action on CHIP based on the assumption that states can keep kids covered with unspent allocation. Yes, all states are projected to have unspent funds and two-thirds can be carried over after September 30 so the funding crisis won’t hit states immediately but there are other important considerations.

Based on the 50-state survey that we conduct with the Kaiser Family Foundation annually, eight states (AL, CO, IA, LA, NY, SC, SD, MA) use ELE to enroll or renew children’s coverage. What happens to those states on October 1, 2017 when ELE expires?

When Congress authorized ELE, it included a sunset clause so that it would have the opportunity to examine the results before committing to making the option permanent. An independent evaluation, conducted in 2013, noted that when implemented in an automated way, ELE processes serve the most individuals, yield the greatest administrative savings, and eliminate procedural barriers to coverage for families. With results like that, why hasn’t Congress permanently authorized ELE yet?

There was promising news coming out of the Senate Finance Committee yesterday that committee leadership has reached a bipartisan agreement to move forward with CHIP legislation. I have not seen the legislative language yet but am optimistic that allowing states to continue to employ the cost-effective ELE option is included. Let’s hope things continue to move expeditiously so that states that use ELE don’t have yet another worry on top of their concerns about whether funding will be renewed for the nearly 9 million children who rely on CHIP.T

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