We have long been fans of the enormous success
that Louisiana has had in improving retention among children in Medicaid and
CHIP through administrative renewals and ex parte. I mean, really, who wouldn’t
be wowed by the fact that just 1% of children lose coverage at renewal for
procedural reasons! Not to mention the low, low error rate of 1.5% — far below
the national average of 6.7%. A sought-after combo if there ever was one.
Well, a new study from our friends at the Urban
Institute highlights another combo that shows just why Louisiana continues to
be a shining star in the Medicaid and CHIP world. This time, because of its
success deploying Express Lane Eligibility (ELE), the state is enrolling more
kids and saving administrative dollars.
While I’m a big enthusiast for digging into the process
behind such things, I’m going to skip that part (it is in the report for folks
who are interested) to cut to the chase and talk about outcomes.
More than 10,000 children had Medicaid cases activated in
February 2010 and by December of that year, more than 20,000 children had been
sent Medicaid cards through ELE. More than half of these kids (54%) formally
enrolled in coverage by using their cards to access care. By November 2010, the
state was also renewing coverage through ELE – accounting for about 38% of
renewals over the next year.
While some of these children may have enrolled in
coverage anyways (such as when they needed health care), some of their
characteristics certainly suggest that others may not have. For example, 74% of
the kids enrolled through ELE were over the age of 7, compared to 57% of the
non-ELE enrolled population. ELE also seemed reached kids in corners of the
state where there were the greatest number of uninsured.
I’m sure a question going through your mind is how much
did this fancy new endeavor cost? It took about $600,000 to get the project off
the ground, with more than 90% covered by a grant from RWJF through the
MaxEnroll project. But the return on investment was pretty
Compared to a typical application process costing $116,
ELE-processed apps cost between $12 and $16. If all the kids who were enrolled
through ELE had applied through the regular process, it would have cost at
least $1 million to sign them up for coverage.
The savings at renewal were even greater. A manual
renewal would set the program back $76 and one capitalizing on the state’s
well-known use of data matches would cost about $51 per child. Under ELE,
Louisiana would automatically deem SNAP recipients income-eligible for Medicaid
at really no cost. Just in the first year alone, this streamlining approach
saved between $8 and $12 million.
Importantly those in the state have been happy with the
results – outreach workers believe that ELE has made a difference in enrolling
eligible, but uninsured children who hadn’t been reached through other means
and families received coverage they valued.
Other states have followed suit, with 8 additional states having taking advantage of ELE to enroll or renew coverage for tens of
thousands of eligible, low-income children. Will your state be next?