At a Glance
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Project Time Frame:
Evaluating Express Lane Eligibility
As part of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Congress gave states the option to implement a new policy known as Express Lane Eligibility (ELE). With ELE, a state’s Medicaid and/or CHIP program can rely on another public agency’s eligibility findings to qualify children for public health insurance coverage, even when programs use different methods to assess income or otherwise determine eligibility. To promote adoption of ELE, Congress made it one of eight simplifications states could implement to qualify for performance bonus payments, which were new funds available to states that implemented five of the eight named simplifications and that also increased Medicaid enrollment (CHIPRA Section 104).
Federal and state policymakers are keenly interested in understanding the full implications of ELE as a route to enrolling children, or keeping them enrolled, in public coverage. To that end, CHIPRA also authorized an extensive, rigorous evaluation of ELE. The U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with Mathematica and its subcontractors, the Urban Institute and Health Management Associates, to conduct an independent evaluation of ELE in the Medicaid and CHIP programs.
Evaluators found that ELE adoption can increase enrollment, but the extent of enrollment gains depends on how states specifically implement the policy. Automatic ELE processes serve the most individuals, yield the greatest administrative savings, and eliminate procedural barriers to coverage for families. The other types of ELE states in the study adopted rely on families initiating or returning an application for coverage; as a result, they show more modest descriptive evidence of increasing enrollment, and they produce little or no administrative savings. An analysis of utilization data in four states that adopted ELE finds that most ELE enrollees accessed a variety of health care services; this finding was consistent across states and type of ELE employed. However, the evaluation also found that ELE enrollees are somewhat less likely to use services, and those who do use services do so less intensively compared to similar enrollees who did not enter through ELE. As a result, states adopting ELE may find the children who enroll through ELE are less expensive to cover than their typical beneficiaries.
In addition to the final report, eleven case studies were conducted as part of the evaluation; those case studies will be posted as they become available.
"CHIPRA Mandated Evaluation of Express Lane Eligibility: Final Findings" (December 2013)