1. Getting the Most Bang for the Post-Health Reform Buck Enrolling & Retaining Everyone Who is Eligible The Alliance for Health Reform Briefing December 1, 2009 Washington, DC Ruth Kennedy LaCHIP Director

2. Overview of Discussion Historic look at Medicaid eligibility in Louisiana Policy options for streamlining and simplification Impact of simplification in Louisiana –Enrollment –Eligibility accuracy Lessons learned from CHIP

3. Medicaid Eligibility in Louisiana During the 1990’s 1992 –Asset test for children and pregnant women eliminated –Face-to-face renewals eliminated –Widespread use of community-based organizations for application assistance –Medicaid eligibility was separated from AFDC & Food Stamp agency 1998 –CHIP implemented as Medicaid expansion –Twelve months continuous eligibility for Medicaid as well as CHIP –Aggressive outreach by local Medicaid eligibility staff

4. Discovering the Secret: Retaining Eligible People at Renewal 2000-2001 –Ex parte renewal for all children with active Food Stamp case –Aggressive telephone follow up 2003 –Eliminated requirement for signed renewal form for non-ex parte cases –Rolling or off cycle renewals permitted 2007-2009 & Ongoing –Administrative renewals for low risk cases –Option for web-based renewal

5. Renewal Path for Children— September 2009

6. The Verdict on Eligibility Simplification in Louisiana It works! Continuing robust increases in Medicaid enrollment Dramatic reduction in uninsured children Virtual elimination of closures at renewal for paperwork reasons Administrative savings & “green government” Fundamental shift in eligibility culture

7. But Are They Really Eligible?????? Not self-declaration of income but alternative sources Data driven identification of cases at low risk of ineligibility PERM Medicaid Eligibility Error Rate is 1.54% (25% national average) Evidence that simplification does not necessarily translate to higher errors Policy choices can help reduce vulnerability to errors

8. Why We Express Lane Eligibility (ELE) Option Further reduces administrative effort & exposure to errors –Ex parte: income is cross walked –ELE: eligibility is cross walked State Plan Amendment has been submitted Will initially use SNAP data to automatically enroll children

9. Current Observations from Ten Years in the Trenches If you build it they may come Actual experience challenges classical economic theory In some states, while not statutorily linked, Medicaid eligibility is administratively linked to Food Stamps Be careful what you ask for As long as states must put up part of the cost of coverage—even 5%...

10. 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 10 Ruth Kennedy LaCHIP Director La Department of Health & Hospitals 427 N 4 th St Baton Rouge, LA 70802 Telephone: 225 241 1437 E-Mail: ruth.kennedy@la.gov http://www.lachip.org