Express Lane Eligibility: Time to Put On Our Thinking Caps – Say Ahhh! A Children’s Health Policy Blog

Express Lane Eligibility (ELE) is a relatively simple concept. There are millions of uninsured children eligible for Medicaid and enrolled in other public programs, like school lunch or food stamps. Since they serve the same populations and families have already submitted relevant information, we can create connections between the programs in order help more children access affordable health coverage. Such a commonsense approach doesn’t sound like it should be too heavy of a lift, but once you get below the surface you’ll find many layers that have to be peeled back.

As in many things in life, public programs have a tendency to operate within silos, each having its own applications, staff, rules, and computer systems. I witnessed this first hand when working for The Children’s Partnership (the first group to use the term Express Lane Eligibility) in California to link free school lunch with Medicaid/CHIP
(Medi-Cal and Healthy Families in the state). From legislation to implementation, it was really rewarding but tough: it hadn’t been done before, the culture of working across programs wasn’t there, and the different federal rules governing the programs were a mine field. We had mixed results, which you can read more about

The good news is that the experience in California and other states led to language in CHIPRA to provide more flexibility to states wanting to undertake ELE. (See CCF fact sheet on new CHIPRA options for states.) And last week, CMS released its guidance letter on the new provisions. The most important new tool in the arsenal: Medicaid/CHIP can now use a finding from another public program for purposes of determining eligibility, without regard to differences in methodology. So, if school lunch says a child is at
130% FPL, Medicaid can apply that income finding – even though school lunch
counts income and household size differently. 
The guidance outlines this and other options available to states, from what other programs can be used, new ways to address screen and enroll, and the potential of using automatic enrollment. CMS acknowledges that this is not “one size fits all” and that they will work with states as they consider different alternatives. To help get your juices flowing, the guidance includes key questions to consider and highlights ELE examples using food stamps and state income tax records.

For those interested in pursuing ELE, here are a few of the lessons I learned:


  • Spend the time to build relationships. Don’t assume that the other programs will automatically see the brilliance of your idea. And be sensitive to the other program’s mission and workload issues. It will take time to build the relationships, and you many want to start by getting support from leadership, whether Secretary of Education or Tax Revenue Board.
  • Technology will make or break you. It all comes down to whether the different program computer systems can talk to each other. If they can, you can cut down on manual processes and better target your efforts. For example, simple data runs can cull out those children already enrolled in Medicaid or CHIP (otherwise you spend countless hours processing their applications).
  • The more stuff you ask for, the less successful you will be. Its human nature to not return forms, so the more information you can obtain from the public program or other databases the more likely you will be to enroll children.

The new ELE options maybe most importantly give us permission to be creative in our outreach and enrollment efforts. So let’s all put on our thinking caps. To assist you, there are a number of great resources out there for you to use: Center on Budget and Policy Priorities, The Urban Institute and The Children’s
Partnership’s Express Lane Toolkit

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