It Happened One Night

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By Donna Cohen Ross, Center on Budget and Policy Priorities 

All in one night -- February 11 -- 10,484 eligible children were enrolled into Louisiana's Medicaid program. 

Are you trying to imagine this? If so, you're probably picturing mile-long lines of children winding through Baton Rouge, parents in tow, clutching packets of forms and documents.  A winter storm warning is in effect -- so said the Baton Rouge newspaper that day -- and freezing rain is already pelting the city, with an accumulation of 1 to 2 inches of snow expected overnight. The crowd of babies and toddlers, tweens and teens, and thousands of others are just waiting, waiting, waiting.  You're thinking this is an ill-advised stunt.  Can't be done.  Not even with every eligibility worker plugging away, all night, nonstop. Not even with every family equipped with every bit of paperwork in hand, exactly in order. No way. Your anxiety level is out of control just thinking about it.

If this is where your imagination has taken you, relax.  What really happened in Baton Rouge that night took place calmly and efficiently while those thousands of children, families and eligibility workers were fast asleep.  What really happened was that 10,484 children got enrolled in one fell swoop through a new CHIPRA option called Express Lane Eligibility

All together, in one night ... done!  And they did it using findings from the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program, to determine Medicaid eligibility.  Make no mistake, however.  Louisiana officials didn't just snap their fingers. It took many months of careful planning and preparation -- and coordination with the separate agency that administers SNAP in Louisiana -- to be sure the process would substantially ease enrollment and at the same time preserve program integrity. 

Here's how it worked: State officials started with the knowledge that children who qualify for SNAP are in families with income that meets the test for Medicaid, and a significant proportion are likely to be uninsured.  A file containing all children receiving SNAP benefits was transferred electronically from the computer system at the Department of Social Services to the computer system at the Department of Health and Hospitals, where Medicaid resides. Children already on Medicaid were removed.  The remaining file of children receiving SNAP but not Medicaid provided income findings, as determined based on food stamp rules, as well as the children's Social Security numbers, residency and age.

Under Express Lane there is no need to recalculate income using Medicaid rules. So, these "borrowed" findings are used, along with other necessary information obtained from available data bases (such as U.S. citizenship from the Social Security data base) to determine Medicaid eligibility and enroll the children.

Next, Medicaid cards and decision notices were mailed to the families.  At that point, they were  informed that the last step in this process -- affirming they want to enroll their child in Medicaid -- would happen the first time they use the card to see a doctor or fill a prescription. 

Ruth Kennedy, Louisiana's Medicaid Deputy Director, explains the significance of the February 11th feat:  "Express Lane Eligibility is a huge administrative efficiency and takes advantage of 21st century technology. It demonstrates that we can reduce duplication of effort when government agencies work together."  Ruth says that the state will be monitoring the system to refine the process and make sure that children enrolled through Express Lane are using their health care benefits -- a sign that the new system really works.  Going forward, she anticipates that SNAP findings will be used to automatically enroll children in Medicaid when they are determined eligible for food assistance.  Isn't this just the kind of coordination Secretary Sebelius and Secretary Vilsack were talking about when they joined together to celebrate the first anniversary of CHIPRA last month?  

So, are you still visualizing those 10,484 children standing in line with their families to gain access to health benefits?  Erase that image and instead picture them avoiding unnecessary ER visits, getting critical preventive care, medical treatment and the prescription medications they need.  Nice picture, huh?  Not bad for a night's work!

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As Donna notes, we are closely tracking utlization for the children and youth who were enrolled into Medicaid via ELE.Since this is totally uncharted territory for us, we want to know the degree to which automatic enrollment is actually impacting access to health care.
Already, 2315 ELE enrollees have utlized one or more Medicaid services including--
Dentist: 318
Physician, NP Practioner,FQHC,RHC :955
Optometrist or Opthamologist: 155
Pharmacy: 1196

This begs the question, "why were they not already enrolled when we have done so much to simplify eligibility and enrollment in the last 12 years?" We intend to explore this further and see if we can find some answers that can be incorporated into our messaging and outreach, as we work to enroll the remaining eligible but uninsured children in Louisiana!
Ruth Kennedy, LaCHIP Director

This is so cool, and as usual Donna has managed to provide the technical details of another LA (a.k.a., Ruth Kennedy) achievement with a flair that makes it easy to read and reminds us of why we all do this work -- to get children health care that they need to grow and thrive. Could you guys run health reform implementation for the country??!

I don't know what I'm more impressed by: Donna's writing or Louisiana's achievements! Oregon is paying close attention to LA's successes so that we can replicate them here.

Ruth and Donna are both rock stars. This commonsense approach should be applied in every state. Glad to hear Oregon is ready to jump in.

This story is so timely. The elements of success include vision, political will, technology, strong policy. All elements of what it took to pass HCR, and what it's going to take to implement it. Thanks for making it happen Louisiana and being a role model! Truly impressive. Thanks for sharing it so perfectly, Donna!

Donna broke the process down so cleary that surely our state (Texas) can join the efforts. I love the acknowledgement that express lane is about efficiency and reducing duplication. Many of the community groups doing outreach have struggled during the economy. If the states could at least focus on using express lane for children already affiliated with state agencies (i.e. SNAP, Child Support, Juvenile Probation, etc.) the community groups could focus their limited resources on the CHIP families.

Solutions like this can get states to 100% coverage for eligible children!


I agree with Cathy - Ruth and Donna are rock stars. This world would be a much better place if our two bright ladies got paid like the Rock Stars do.
Way to go Ruth and Donna.


I can almost hear those children's parents sighs of relief all the way here in Cincinnati.....

What great writing! Such a pleasure to read in the midst of the dry prose that prevails in Health Wonk Land.

And more important, what a wonderful step forward for children in LA and example for the rest of the country. Kudos all around!!! Hooray!!!!


The utilization data is proof of the effectivneness of ELE. Making people eligible is step one, using that coverage is what's most important. Congratulations to Louisiana!


As an eligibility worker (in LA), I know that our LaCHIP application can be processed in about 15-30 minutes. Although it probably took thousands of hours of planning and development for implementation of ELE, think of all the eligibility processing time that was saved the very night that the program began!


As a Medicaid eligibility worker in Louisiana, I remember all too well the days of having to personally interview the applicants. It was time consuming for the worker and posed logistical problems for the folks applying. This area of Louisiana (in the Northeast corner of the state) has an extremely high poverty rate and many of the people who were most in need of our help were hampered by an inability to GET to our office. In our mainly rural area, there really isn't any public transportation available, so many of the neediest in our area had to pay someone to bring them to our office. The Express Lane has been a relief for many in our community, as well as for us as eligbility workers. It will be very interesting to see if other states follow suit. I hope that they do since it's been a win-win situation in our state.

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