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Express Lane Eligibility: Using Public Programs to Enroll Eligible Children into Medicaid/SCHIP. 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
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Express Lane Eligibility: Using Public Programs to Enroll Eligible Children into Medicaid/SCHIP
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@georgetown.edu ccf.georgetown.edu State Coverage Initiatives Program May 22, 2007
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.
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.
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 America’s Families (NSAF).
Other Public Programs have Similar Income Eligibility Rules • School Lunch 185% FPL • WIC 185% FPL • Food Stamps 130% FPL
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.
Types of Express Lane • Targeted Outreach • Streamlined Application • Automatic Income Eligibility
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
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
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
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
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
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
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
For More Information www.expresslaneinfo.org