May 14, 2009 An Overview of Express Lane Eligibility in CHIPRA 2009 Beth Morrow Staff Attorney The Children’s Partnership NASHP Webinar

Lessons from pre-CHIPRA Express Lane-Style Efforts Underlying mismatched program rules prevented streamlined cross-program enrollment We learned that efficient cross-program enrollment would require: Ex parte solutions (data-driven) Single step for the family Technology to support the process Administrative simplicity -- for the family, the Medicaid/CHIP agency, and for the other program agency

CHIPRA Sec. 203 At it’s essence: Express Lane Eligibility (ELE): Medicaid and the Children’s Health Insurance Program (CHIP) are now allowed to borrow eligibility findings from other programs to determine eligibility and/or conduct renewals. This is true even when the other program uses a different budget unit, disregard, deeming, or other methodology to make its finding.

Borrowing Eligibility Findings States have significant flexibility to choose which and how many eligibility findings to borrow. - Examples: income level (%FPL), immigration, residency, etc. CHIPRA sets these parameters: The finding(s) must have been made within a “reasonable time period,” as determined by the state. States are still required to verify citizenship and nationality status (now for both Medicaid and CHIP), but they can use electronic means to do so (via SSA). Of course, as was true prior to CHIPRA, states can also borrow eligibility information.

Choosing an Express Lane Agency States have lots of flexibility to choose the program that makes sense for them. CHIPRA 2009 lists 12 specific programs that can be ELE agencies, but this list is not meant to be exhaustive. The limitation is: The agency must have fiscal liability or legal responsibility for the accuracy of the finding. The agency cannot be a private, for-profit organization. The agency cannot be the eligibility agency for a program established under Title XX of Soc. Svc. Block Grant.

Protections Protections were included to ensure that children are not disadvantaged by this new methodology. Where a child is found ineligible under ELE, he/she will be evaluated through standard eligibility rules. Screen and Enroll is still required, although an ELE effort can implement a unique procedure (next slide).

Screen and Enroll in ELE Screen and Enroll Option #1: Set a screening threshold at 30 percent above the highest Medicaid income threshold. If a child falls under this threshold, they are deemed Medicaid-eligible, and, if they are above it, they are deemed CHIP-eligible. Before enrolling a child in CHIP, the family must be informed of potential eligibility for Medicaid and the differences in the programs, and they must be given an opportunity to apply for a determination under standard Medicaid rules.

Screen and Enroll (Cont.) Screen and Enroll Option #2: Temporarily enroll those children who appear eligible for CHIP into CHIP (based on the borrowed findings), pending a simplified determination of eligibility that does not require families to provide duplicative information. Under both options, the federal matching rate will be for the program in which the child is placed, even where that placement may be temporary.

Removes Barriers to Data-Driven Enrollment Allows for Automatic Enrollment (Stan will be discussing). Addresses where consent is needed to enable data-sharing. Addresses the need for interagency agreements that define the proper use of shared data. Clarifies that states can accept electronic signatures. Allows states to borrow eligibility components without obtaining attestation and signature as to those facts. Provides access to additional, relevant databases. National Directory of New Hires, third party payer databases

Provides Funding that can Help ELE Efforts Performance Bonus System: ELE is one of the practices that helps a state qualify for performance bonuses. Provides standard administrative matching funds to support eligibility systems improvements. Provides enhanced match to build systems connection to SSA. Establishes outreach grant program. Stimulus funds may help, too.

Evaluation Protects states from penalties for errors that occur through the ELE procedure. Children enrolled through ELE are not included in MEQC and PERM evaluations. No punitive action will be taken where the sample finds excessive errors among the ELE enrollees. Requires states to evaluate their results by 2012.

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