Briefs & Reports

Express Lane Eligibility Evaluation Findings

Mathematica

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.