Louisiana: Streamlining Enrollment with Express Lane Eligibility

On February 11, 2010, more than 10,000 Louisiana children were automatically enrolled in the state's Medicaid program. Families received their Medicaid cards in the mail and were notified that their initial use of the card would affirm they want to enroll their child in the program.

Louisiana accomplished its enrollment increase for children using "Express Lane Eligibility," an enrollment process promoted by CHIPRA, which allows information from a state-designated "Express Lane agency" to be used to determine whether a child satisfies one or more factors of eligibility for Medicaid or CHIP. In this case, the Louisiana Department of Social Services provides information from the State's Supplemental Nutrition Assistance Program (SNAP) that the Department of Health and Hospitals then uses to determine eligibility for Medicaid and CHIP.

Louisiana Medicaid and SNAP officials worked together intensively for nearly a year to make the new system work. They transferred information about all children receiving SNAP benefits to the Medicaid program—including income findings determined by food stamp rules, Social Security numbers, residency, and age—to determine eligibility for Medicaid and CHIP. Under Express Lane Eligibility, Medicaid "borrows" information from other programs to establish eligibility and enroll the children.

The state is monitoring the system to refine the process and make sure that children enrolled through Express Lane Eligibility are actually using health care benefits. "Enrollment alone is not our endgame," says Ruth Kennedy, Louisiana CHIP director and Medicaid deputy director. "I am pleased to report that more than 30 percent of the children who were automatically enrolled have already used services—dentists, eye doctors, physicians, early screening and diagnostic testing, and prescription drugs."

Now the state is turning its attention to automatically renewing for 12 months any child with an active SNAP case, and looking ahead to designating more Express Lane agencies, including Child Care Assistance, Women Infants and Children nutrition programs, and the Free and Reduced Lunch program. The children on these programs are among the state's most vulnerable, says Kennedy. "I am cautiously optimistic that Express Lane Eligibility will be a major factor in identifying the 30,000 or so eligible but still uninsured children in Louisiana and getting them enrolled."

Even before this policy change, Louisiana had made significant progress streamlining eligibility and enrollment systems in the priority areas CHIPRA identifies. It was one of nine states to receive bonus payments under CHIPRA for having in place at least five of eight administrative simplification policies and meeting enrollment growth targets in 2009.