Louisiana does it again: The first use of Express Lane Eligibility to automate children's enrollment and retention

Created as an option under the CHIP Reauthorization Act, “Express Lane Eligibility” (ELE) lets states qualify children for Medicaid and CHIP based on their eligibility for other programs, such as the Supplemental Nutrition Assistance Program (SNAP). This study examines ELE's impacts on children's enrollment into Medicaid, state administrative costs, program integrity, and beneficiary experiences, in Louisiana, the first state to implement ELE's auto-enrollment feature.

Based on analysis of state administrative data, as well as findings from key informant interviews and focus groups with parents of child enrollees, we found that ELE effectively enrolled thousands of previously uninsured children, simplified the process through which these children were found eligible, and lowered state administrative costs related to outreach, enrollment, and renewal.

Specifically, in February 2010, Louisiana enrolled more than 10,000 children into Medicaid in a single night, based on data matches with SNAP. Since then, more than 4,000 additional children were enrolled. Among new enrollees, more than 30 percent used their Medicaid coverage to obtain care soon after enrollment. The state also used ELE to automatically renew Medicaid coverage if data matches showed that, as Medicaid eligibility periods were ending, children were receiving SNAP. This expedited 25 percent of all renewals, yielding administrative savings.

Louisiana's experience suggests that, compared to traditional, more burdensome methods of qualifying families for need-based assistance, ELE yields significant gains in participation while improving administrative efficiency. These lessons can help guide policymakers in other states on implementing children's coverage under federal health reform.