CHIPRA Mandated Evaluation of Express Lane Eligibility: Final Findings Final Report December 2013 Mathematica Policy Research Sheila Hoag Adam Swinburn Sean Orzol Michael Barna Maggie Colby Brenda Natzke Christopher Trenholm Urban Institute Fredric Blavin Genevieve M. Kenney Michael Huntress With Jennifer Edwards Eileen Ellis Rebecca Kellenberg Diana Rodin Sharon Silow-Carroll Health Management Associates And Brigette Courtot Ian Hill Margaret Wilkinson Stan Dorn Sarah Benatar Urban Institute This page has been left blank for double-sided copying. Mathematica Reference Number: 06988.920 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: Mathematica Policy Research 600 Alexander Park Suite 100 Princeton, NJ 08540 Telephone: (609) 799-3535 Facsimile: (609) 799-0005 Project Director: Sheila Hoag CHIPRA Mandated Evaluation of Express Lane Eligibility: Final Findings Final Report December 2013 Mathematica Policy Research Sheila Hoag Adam Swinburn Sean Orzol Michael Barna Maggie Colby Brenda Natzke Christopher Trenholm Urban Institute Fredric Blavin Genevieve M. Kenney Michael Huntress With Jennifer Edwards Eileen Ellis Rebecca Kellenberg Diana Rodin Sharon Silow-Carroll Health Management Associates And Brigette Courtot Ian Hill Margaret Wilkinson Stan Dorn Sarah Benatar Urban Institute This page has been left blank for double-sided copying. Mathematica Policy Research CONTENTS EXECUTIVE SUMMARY .......................................................................................................... XI I. THE FEDERAL EVALUATION OF EXPRESS LANE ELIGIBILITY ............................. 1 A. Purpose of this Report ............................................................................... 2 B. What is Express Lane Eligibility? ............................................................... 2 C. Potential Benefits of ELE ........................................................................... 2 1. Potential Coverage Gains ............................................................................. 2 2. Potential Administrative Savings Resulting from Administrative Efficiencies .................................................................................................... 3 3. Shorter Wait Times ....................................................................................... 4 D. Other Approaches to Expanding Coverage and Simplifying Enrollment and Renewal ............................................................................ 4 E. Overview of the ELE Evaluation ................................................................ 5 1. Evaluation Goals ........................................................................................... 5 2. Research Questions Addressed by This Report and Data Sources Used to Answer Them ..................................................................... 7 3. Evaluation States .......................................................................................... 8 F. Road Map for the Report ........................................................................... 9 II. KEY DESIGN FEATURES OF ELE IN EVALUATION STATES ................................ 13 A. Background and Motivation ..................................................................... 13 B. Data Collection and Analysis Methods..................................................... 13 C. Comparison of Key ELE Features in Eight States ................................... 14 D. Descriptions of ELE Processes Adopted in Eight States ......................... 21 1. Alabama...................................................................................................... 21 2. Iowa ............................................................................................................ 22 3. Louisiana .................................................................................................... 23 4. Maryland ..................................................................................................... 24 5. Massachusetts ............................................................................................ 25 6. New Jersey ................................................................................................. 25 7. Oregon ........................................................................................................ 26 8. South Carolina ............................................................................................ 27 E. Discussion ............................................................................................... 27 iii Contents Mathematica Policy Research III. ASSESSING ELE’S IMPACT ON ENROLLMENT: AN UPDATED ANALYSIS OF THE STATISTICAL ENROLLMENT DATA SYSTEM ........................ 29 A. Background