Using Food Stamp Data to Implement ELE in Louisiana New CHIPRA Opportunity: Express Lane Eligibility NASHP Webinar May 14, 2009 J. Ruth Kennedy La. Dept of Health & Hospitals

ELE is the Law in Louisiana! The department, upon enactment by Congress of legislation allowing the same may utilize income determinations made by the Food Stamp Program, WIC, or National School Lunch Program for determining income eligibility for the Louisiana Medicaid program or LaCHIP. La. R.S. 46:977.8

Why We Believe ELE is Important for Louisiana’s Kids Highest % of state’s uninsured kids are from 50% to 100% FPL Literacy issues “Simplicity” of enrollment is relative Complicated lives Different agencies determine Medicaid/CHIP and FS, WIC, and School Lunch eligibility Parental priorities Maslow’s hierarchy of needs The highest percentage of uninsured children below 200% of poverty live in families with income between 50 and 100% of poverty. We’re confronted with Literacy issues Parental priorities are very much driven by Maslow’s hierarchy of needs. On most days, health coverage isn’t exactly at the top of their “Things to Do Today” list And the simplicity of enrollment that we tout is relative. Simple compared to 1998? Yes Simple? Well, not really This population moves frequently—often living with others--resulting in constant address changes and fewer attachments to the community. Of course for us Hurricane Katrina just further exacerbated this problem.

Ex Parte Renewals Using Food Stamp Data Since 2001 High level of confidence in Food Stamp income data Match with FS system identifies & flags children due for renewal with active FS case Caseworkers still play major role in decision making Income in FS system for Medicaid/CHIP income unit members is cross walked ~ 2/3 of Medicaid children are in active FS case Has resulted in dramatic reduction in procedural (paperwork) closures

Why Move from FS Ex Parte to FS ELE Renewals? Further reduction in administrative costs No longer a need for caseworker action Reduces our exposure to eligibility errors True ELE cases excluded from QC and PERM Regardless of age kids over/under 100% FPL eligible for Medicaid With Medicaid stimulus, higher FMAP for Medicaid than CHIP thru 12/31/10! Performance bonuses based on Medicaid increase

Draft Plan for Automatic Enrollment Using ELA Data File of children <19 received from ELA We do file match with Medicaid and CHIP & remove children with coverage File match through TPL contractor and remove children with private insurance Mail required info about Medicaid and “call toll-free number to activate” card During call, obtain any additional information to certify case & certify case if eligible mother’s maiden name to verify citizenship via Vital Records Current income information

State Plan Amendment is Required to Implement ELE Cannot develop SPA without CMS guidance Will CMS issue a template? What degree of detail will be required? Once submitted, how quickly can we expect approval?

Decisions States Must Make Selection and prioritization of Express Lane Agencies ELE for Medicaid only or Medicaid and CHIP ELE for applications, renewals, or both Definition of ‘reasonable period” Eligibility components to be verified via ELA Medicaid “screen and enroll” threshold amount

Express Lane Agency Issues ELA application and renewal form must be revised Can addendum to application be used? Willingness and capacity to modify their intake process Additional ELA costs Forms revision Staff training System changes Execution of data sharing agreement or MOU

Coding Requirements and Implications CMS responsible for establishing coding guidance Adequate data is essential for monitoring What we need to know-- Application or renewal? ELA classification/identity Demographics of ELE enrolled child Previously enrolled in public coverage? Automatic Enroll or something less? Number who “opt out

Planning Ahead for the Mandated Evaluation Law requires evaluation of ELE to Congress by 9/30/12 $5 M (they’re serious about this) Lessons learned about evaluations Keep notes of planning meeting Administrative cost data—traditional as well as ELE Data, coding, back end reports

Early ELE Implementation Hurdles in Louisiana Only School Lunch application currently contain “opt out” language Discovery of potential ELAs’ reliance on other program eligibility, rather than collecting income SPA submission requires administrative rulemaking Administrative rule making requires fiscal impact analysis Fiscal impact analysis cannot be completed without CMS guidance

ELE “Readiness” Activities in Louisiana Request to FS agency for opt out language revision to forms Identifying public agencies “capable” of determining income eligibility at 97% or higher rate of accuracy Collecting application forms Reviewing income policies Determining data fields from ELA needed for fully Automated Enrollment Annual volume estimates for both renewals and applications Planning for eligibility review of ELE sample

Our Wish List from CMS (Sooner Rather than Later) State Plan pages template Data and coding requirements Model language Guidance on full review for statistically valid sample Definition of “prompt follow up” for children temporarily enrolled in CHIP ELE-specific call with states (after guidance is released)

Never doubt that a small group of thoughtful, caring people can change the world Indeed, it is the only thing that ever has !— Dr. Margaret Mead Ruth Kennedy LaCHIP Director & Medicaid Deputy Director Louisiana Department of Health & Hospitals P.O. Box 91030 Baton Rouge, LA 70821-9030 Telephone: 225 342 3032 Blackberry: 225 241 1437 Fax: 225 342 9508 E-Mail: ruth.kennedy@la.gov www.lachip.org