Louisiana Breaks New Ground: The Nation's First Use of Automatic Enrollment Through Express Lane Eligibility

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, and beneficiary experiences in the State of Louisiana, the first state to implement ELE's auto-enrollment feature.

Based on analysis of state administrative data, key informant interviews with state and local officials 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.

Between February and December 2010, Louisiana enrolled more than 20,000 children into Medicaid based on data matches with SNAP. Among new enrollees, more than 50 percent used their Medicaid coverage to obtain care after enrollment. The state also used ELE to automatically renew Medicaid coverage if data matches showed that children were receiving SNAP. This expedited 38 percent of all renewals.

ELE has proven to be less costly than traditional methods. Administrative data revealed that the state saved approximately $1 million on enrollment costs during ELE's first year; renewal saving were even greater--$8 million annually.

Compared to traditional, more burdensome Medicaid eligibility processes, ELE yields significant gains in child coverage while improving administrative efficiency, lessons that may help state and federal policymakers implementing children's coverage under health reform.