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Express Lane Eligibility Evaluation Findings

March 24, 2014


The U.S. Department of Health and Human Services recently submitted a final independent evaluation of the Express Lane Eligibility (ELE) policy to Congress. Health Management Associates and The Urban Institute worked with Mathematica Policy Research to conduct this multi-year review.

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) gave states the ability to utilize ELE. With ELE, Medicaid and CHIP programs can use data gathered by another agency to determine if a child is eligible for enrollment. As ELE was a new option to address the number of children eligible yet not enrolled in publicly funded health care programs, the legislation required a comprehensive review of its impact.

The final report to Congress examines how different states implemented ELE, estimates the impact of ELE adoption on total enrollment, takes a look at enrollment and renewal trends along with administrative costs and/or savings, and reviews service utilization.

The Final Findings

  • ELE adoption can increase enrollment.
  • States have adopted ELE differently, and those differences can affect its potential benefits.
  • Automatic ELE processes serve the most individuals, yield the greatest administrative savings, and eliminate procedural barriers to coverage.
  • Simplified procedure and simplified application ELE processes, which rely on families initiating or returning an application for coverage, produce little to no administrative savings and show more modest descriptive evidence of increasing enrollment.
  • Given the size of renewal caseloads compared to new enrollment caseloads and the recurring nature of renewal, using ELE for renewals holds great promise for administrative savings and keeping kids covered.
  • ELE enrollees use health care services, though fewer than those who enroll through standard routes.
  • Like ELE, all three of the other simplifications studied can help simplify the enrollment or renewal process for families, but they differ in their reach and impact.

As part of the evaluation process, HMA Managing Principal Jennifer Edwards and Senior Consultant Diana Rodin also produced a Case Study of Massachusetts’ Express Lane Eligibility Processes. Managing Principal Sharon Silow-Carroll and Diana Rodin produced a Case Study of New York’s Telephone Renewal in Medicaid. Jennifer Edwards and Rebecca Kellenberg produced a Case Study of South Caroliina's Express Lane Eligibility Processes.


Strengthening the Value and Performance of Health Insurance Market Conduct Examination Programs: Consumer Recommendations for Regulators and Lawmakers

February 21, 2014

National Association of Insurance Commissioners

The National Association of Insurance Commissioners (NAIC) report, “Strengthening the Value and Performance of Health Insurance Market Conduct Examination Programs: Consumer Recommendations for Regulators and Lawmakers” was created to serve as a resource that could offer guidance to lawmakers, regulators, the NAIC and others in light of the Affordable Care Act’s new consumer protections.

HMA Principal Dianne Longley conducted the research and authored this report for the NAIC. The report takes a look at market conduct examinations and highlights best practices.


Accountable Care in the Safety Net

February 6, 2014

Terry Conway, MD | Managing Principal | Contributor
Pat Terrell | Managing Principal | Contributor

Accountable Care has emerged as a critical delivery system redesign companion to expanded coverage within federal health reform. Accountable Care calls for providers to organize to provide a full continuum of care to patients and populations, to commit to improving quality while controlling cost, and to be rewarded as they succeed. However, the principles of Accountable Care are based upon demonstrations and lessons learned primarily in Medicare populations served by highly organized and integrated health systems.

The Safety Net differs in the patient populations it serves, the structures and relationships between its providers, and its funding, which is mainly concentrated in Medicaid and local government reimbursement. Thus, the federal emphasis on the development of Accountable Care will need to be tailored differently for the Safety Net. Further, California’s Safety Net will face the challenges of building collaborative delivery models earlier than the rest of the nation as the renewal of the State’s 1115 Medicaid Waiver is implemented during the next year. These State and national moves toward integrated care offer both opportunity and challenge to the Safety Net and progress toward Accountable Care will be made only after embarking on an honest and thorough examination of necessary changes in relationships and organization, delivery system design, infrastructure, and revenue distribution.

Taking leadership now to create Accountable Care is a strategy that is most likely to secure the ongoing existence of Safety Net providers, assure access for the patients they have historically served, and improve the health status of their communities. It is also a strategy that is likely to gain the support of the federal government as new models are sought to efficiently and effectively deliver care for a population that will soon represent the single largest publically‚Äźfunded health coverage program.


Medicaid Enrollment: June 2013 Data Snapshot

January 31, 2014

The Henry J. Kaiser Family Foundation

HMA Managing Principal Eileen Ellis and Senior Consultant Dennis Roberts helped the Henry J. Kaiser Family Foundation (KFF) assemble the June 2013 Medicaid Enrollment Data Snapshot.

The issue brief provides data about monthly Medicaid enrollment trends from all 50 states. In June 2013, 55 million people were enrolled in Medicaid. While this was a 1.5 percent increase in enrollment from the previous year, enrollment increased at the slowest rate since the start of the Great Recession.

As the Affordable Care Act (ACA) is implemented across the country, Medicaid enrollment is expected to significantly increase. This report provides baseline data for understanding the impact of the ACA eligibility and enrollment policies on enrollment growth in states. 


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