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

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Express Lane Eligibility Using Public Programs
to Enroll Eligible Children into Medicaid/SCHIP
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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 dch28_at_georgetown.edu ccf.georgetown.edu
State Coverage Initiatives Program May 22, 2007
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What is Express Lane Eligibility?
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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.
  

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Why Express Lane Eligibility?
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Most Uninsured Children Are NowEligible for
Public Coverage (2004)
SCHIP Eligible
Medicaid Eligible
Medicaid Eligible
SCHIP Eligible
Not Eligible
Not Eligible
All Uninsured Children
Low-income Uninsured Children
Source L. Dubay analysis of March 2005 Current
Population Survey using July 2004 eligibility
rules.
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Most Uninsured Children Participate in other
Public Programs
Low-Income, Uninsured Children Whose Families
Participated in Other Public Programs, 2002
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 2006. Authors tabulations based
on 2002 National Survey of Americas Families
(NSAF).
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Other Public Programs have Similar Income
Eligibility Rules

• School Lunch ? 185 FPL
• WIC ? 185 FPL
• Food Stamps ? 130 FPL

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Legislative Precedents

• WICs Adjunctive Eligibility accepts an
  applicants documented participation in Medicaid,
  Food Stamps and TANF as evidence of income
  eligibility for WIC.
• NSLPs Categorical Eligibility and Direct
  Certification deems children receiving Food
  Stamps, FDPIR and TANF automatically eligible for
  free meals and milk.

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How Have States Used Express Lane Eligibility?
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Types of Express Lane

• Targeted Outreach
• Streamlined Application
• Automatic Income Eligibility

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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

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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

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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

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A Case Study Californias Express Lane Program
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About Californias Express Lane Program

• Linked Medicaid/SCHIP with free school lunch
• Began July 2003 5 pilot school districts (70
  schools) LA, Fresno, San Diego, Redwood City
  (San Mateo) and Alum Rock (Santa Clara)
• 10 districts implemented by 2005-06 school year

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Californias 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

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Californias 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

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Continuing the Progress
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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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For More Information

• www.expresslaneinfo.org