CHIPRA Express Lane Eligibility Evaluation: Case Study of Alabama’s Express Lane Eligibility

CHIPRA Express Lane Eligibility Evaluation Case Study of Alabama’s Express Lane Eligibility Final Report January 13, 2014 Margaret Wilkinson Brigette Courtot Ian Hill ii This page has been left blank for double-sided copying. iii Mathematica Reference Number: 06988.700 Submitted to: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation 200 Independence Ave., SW Washington, DC 20201 Project Officer: Rose Chu Submitted by: Urban Institute 2100 M. St. NW Washington, DC 20037 Telephone: 202-261-5561 Facsimile: 202-223-1149 Project Director: Sheila Hoag, Mathematica Policy Research CHIPRA Express Lane Eligibility Evaluation Case Study of Alabama’s Express Lane Eligibility Final Report January 13, 2014 Margaret Wilkinson Brigette Courtot Ian Hill This page has been left blank for double-sided copying. 1 Contents Executive Summary ....................................................................................................................................... 2 1. Introduction .............................................................................................................................................. 6 2. State Context : Why Pursue ELE? .............................................................................................................. 7 3. Planning and Design ................................................................................................................................ 11 4. Implementation ...................................................................................................................................... 13 5. Outcomes ................................................................................................................................................ 19 6. Looking Ahead ......................................................................................................................................... 21 7. Lessons Learned ...................................................................................................................................... 23 8. Conclusion ............................................................................................................................................... 25 Works Cited ................................................................................................................................................. 26 2 Executive Summary In October 2009, the Alabama Medicaid Agency implemented an Express Lane Eligibility (ELE) partnership with the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) programs—both administered by the Department of Human Resources (DHR)—to facilitate the enrollment and renewal of children into Medicaid. Under Alabama’s ELE initiative, Medicaid uses income eligibility findings from SNAP and TANF to automatically renew coverage for children enrolled in Medicaid and women enrolled in Plan First, a Medicaid program that provides family planning services to low-income women of childbearing age. Though CHIPRA does not authorize the use of ELE for adults, Alabama received federal approval to use ELE for Plan First via an 1115 Medicaid waiver. In addition to the auto-renewal approach, the state also operates a manual ELE process, under which Medicaid eligibility workers in the state can use SNAP and TANF income eligibility information to process Medicaid eligibility for children and Plan First enrollees at renewal and/or the time of initial application. Table ES.1 summarizes key facts about Alabama’s ELE program. Alabama has long been a committed leader in supporting children’s public coverage through progressive eligibility policies. Since the early 2000s, the Covering Kids and Families coalition—comprised of state officials, child and family advocates, providers, and other stakeholders—had been considering policies that would streamline Medicaid and CHIP enrollment for children, based on their receipt of other public benefits. The passage of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) in 2009 paved the way for Alabama to adopt such a policy under CHIPRA’s ELE option, at a time when recession-related hiring freezes and caseload increases were overwhelming Medicaid’s already-lean eligibility department and state policymakers were especially receptive to policy changes that would increase efficiency and automation. Hence, Medicaid officials moved quickly to implement ELE in collaboration with its partner agency, DHR. SNAP and TANF were natural choices as partner programs for Alabama ELE, because both have eligibility limits within the range of Medicaid income limits and Medicaid eligibility workers were already familiar with accessing DHR databases when processing Medicaid applications. Just as importantly, DHR staff had long-supported the concept of using infor