Express Lane Eligibility: Using Public Programs to Enroll Eligible Children into Medicaid/SCHIP

Dawn Horner Georgetown University Health Policy Institute Center for Children and Families ccf.georgetown.edu State Coverage Initiatives Program May 22, 2007 Express Lane Eligibility: Using Public Programs to Enroll Eligible Children into Medicaid/SCHIP

What is Express Lane Eligibility?

Express Lane Eligibility is: A strategy for using other public programs, like WIC and School Lunch, to make it easier for eligible children to enroll into Medicaid/SCHIP.

Why Express Lane Eligibility?

Most Uninsured Children Are Now Eligible for Public Coverage (2004) SCHIP Eligible Not Eligible Medicaid Eligible SCHIP Eligible Not Eligible Medicaid Eligible All Uninsured ChildrenLow-income Uninsured Children Source: L. Dubay analysis of March 2005 Current Population Survey using July 2004 eligibility rules.

Most Uninsured Children Participate in other Public Programs Source: S. Dorn and G. Kenney, Automatically Enrolling Eligible Children and Families Into Medicaid and SCHIP: Opportunities, Obstacles, and Options for Federal Policymakers, Economic and Social Research Institute and the Urban Institute, June Authors’ tabulations based on 2002 National Survey of America’s Families (NSAF). Low-Income, Uninsured Children Whose Families Participated in Other Public Programs, 2002

Other Public Programs have Similar Income Eligibility Rules School Lunch  185% FPL WIC  185% FPL Food Stamps  130% FPL

Legislative Precedents WIC’s Adjunctive Eligibility: accepts an applicant’s documented participation in Medicaid, Food Stamps and TANF as evidence of income eligibility for WIC. NSLP’s Categorical Eligibility and Direct Certification: deems children receiving Food Stamps, FDPIR and TANF automatically eligible for free meals and milk.

How Have States Used Express Lane Eligibility?

Types of Express Lane Targeted Outreach Streamlined Application Automatic Income Eligibility

Targeted Outreach Target outreach to uninsured children in public programs with similar eligibility guidelines. Most widely used through school lunch. Include Medicaid/SCHIP application or outreach materials with program applications. Include question on application or separate form asking parents if families want to receive health information. –Example : Chicago Public Schools

Streamlined Application Information already collected by a public program is used to streamline the Medicaid/SCHIP application process. Use public program application as start of Medicaid/SCHIP application. Seek further information, such as immigration status, to make a final eligibility determination. –Example: New Jersey, Washington State, California

Deemed Eligibility Use the fact that a child is enrolled in an income- comparable program as the basis for determining the child to be income-eligible for Medicaid or SCHP. Deem children income eligible if public program more restrictive than Medicaid/SCHIP program. –Example: New York

A Case Study: California’s Express Lane Program

About California’s Express Lane Program Linked Medicaid/SCHIP with free school lunch Began July pilot school districts (70 schools): LA, Fresno, San Diego, Redwood City (San Mateo) and Alum Rock (Santa Clara) 10 districts implemented by school year

California’s Express Lane Program: How it Works School lunch application modified to include information required to make initial Medicaid eligibility determination and to request consent. Schools serves as “qualified entity” and make presumptive eligibility determination. Counties provide presumptive coverage within 5 working days. County sends families one page follow-up form to make final eligibility determination

California’s Express Lane Program: Results School Lunch Program is a fruitful gateway to health insurance and enrolling children in Medi-Cal –If ELE were applied statewide, it could reach up to 500,000 uninsured children in CA Children received presumptive eligibility: 68% of those who applied and were not already enrolled Fewer children than hoped enrolled in ongoing coverage: 40% of children that presumptive coverage received ongoing coverage

Continuing the Progress

Lessons Learned/Moving Forward States Can Do a Lot Now to Implement Streamlined Mechanisms Federal Assistance Needed to Move Toward Automatic Computer System/Technology Simplifications Critical to Success Need for Outreach/Follow-Up to Families Never Goes Away

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