Download - 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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Dawn HornerGeorgetown University Health Policy Institute
Center for Children and [email protected]
ccf.georgetown.edu
State Coverage Initiatives ProgramMay 22, 2007
Express Lane Eligibility: Using Public Programs to Enroll Eligible
Children into Medicaid/SCHIP
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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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19%
32%
49%
Most Uninsured Children Are NowEligible for Public Coverage (2004)
21%13%
66%
SCHIP Eligible
Not Eligible
Medicaid Eligible
SCHIP Eligible
Not Eligible
Medicaid 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
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 America’s Families (NSAF).
59
22
8
71
01020304050607080
Percent
NSLP WIC FoodStamps
Any ofthese
programs
Low-Income, Uninsured Children Whose Families Participated in Other Public Programs, 2002
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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
• 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.
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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: California’s Express Lane Program
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About California’s 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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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
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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
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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