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State Use of Express Lane Eligibility for Medicaid and CHIP Enrollment

WHY WE DID THIS STUDY

Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance coverage for certain low-income children, yet millions of eligible children are still uninsured. To increase enrollment of eligible children, Congress authorized States to adopt the Express Lane Eligibility (ELE) option, which allows States to expedite and simplify enrollment in Medicaid and CHIP by relying on findings from other agencies' eligibility determinations. Congress will determine whether to reauthorize the ELE option in 2017. We conducted this study in response to a Congressional request that the U.S. Department of Health and Human Services, Office of Inspector General (OIG) examine the benefits and barriers to State use and expansion of ELE. This report is being issued concurrently with two OIG audits that fulfill a Congressional mandate to assess whether State agencies met Federal requirements in making eligibility determinations using ELE and developing eligibility error rates.

HOW WE DID THIS STUDY

We administered questionnaires and conducted telephone interviews with Medicaid and CHIP officials from the 14 States that adopted ELE. Where available, we supplemented this information with enrollment and cost savings data collected from the States.

WHAT WE FOUND

States that used ELE adopted variations of three models, with more than half adopting an automated model that requires minimal action from staff and beneficiaries. All 14 States that used ELE reported benefits, including reduced administrative burden and cost savings, and some States reported that they rely heavily on ELE. Eleven States reported that they encountered barriers when they implemented ELE, such as problems sharing information across agencies, but reported that they overcame these barriers through strong partnerships and integrated eligibility systems. Despite largely positive experiences using ELE, 5 of the 14 States that adopted ELE discontinued its use, mainly because of competing priorities, system changes, and short-term agreements with partner agencies. None of the 9 States still using ELE plan to expand its use.

WHAT WE CONCLUDE

Although State use of ELE is not widespread, ELE appears to meet the intended objective of easing the eligibility and enrollment process. Implementation of ELE is consistent with the goals of the Patient Protection and Affordable Care Act provisions to streamline enrollment processes for Medicaid and CHIP. Based on this review of State experiences with ELE, OIG did not identify any significant impediments to continuing to allow voluntary use of ELE, once States and CMS have corrected process problems and gaps in oversight identified by OIG audits of ELE enrollments. Reauthorization of the ELE option would allow States that rely on ELE to continue its use and give other States the opportunity to adopt ELE and likely experience similar benefits.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201