Express Lane Eligibility for Medicaid and CHIP Coverage
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) included many provisions designed to give States the tools they need to effectively enroll eligible children in Medicaid and the Children’s Health Insurance Program (CHIP). One of the key tools that CHIPRA created is the Express Lane Eligibility (ELE) option. ELE provides States with important new avenues to ensure that children eligible for Medicaid or CHIP have a fast and simplified process for having their eligibility determined or renewed.
Express Lane Eligibility permits States to rely on findings, for things like income, household size, or other factors of eligibility from another program designated as an Express Lane agency to facilitate enrollment in health coverage. Express Lane agencies may include: SNAP, School Lunch, TANF, Head Start, and WIC among others. A State may also use information from State income tax data to identify children in families that might qualify and so that families do not have to submit income information.
For more information about how States are implementing Express Lane Eligibility, click on the States below. Learn more about the requirements for Express Lane Eligibility (PDF 329.22 KB).
Status of Express Lane Eligibility SPAs and Waivers – July 22, 2013
To date, fourteen States have submitted SPAs to CMS and two States have submitted 1115 demonstration requests to implement CHIPRA Section 203, which permits States to rely on findings from an Express Lane agency to conduct simplified eligibility determination and facilitate enrollment in Medicaid and CHIP. This page summarizes the status of pending and approved SPAs and 1115 demonstrations.
Number of SPAs
|SPA Approved-Medicaid||AL, IA, LA, NJ, MD, OR, GA, SC, CO, MA, USVI, NY|
|SPA Approved-CHIP||OR, NJ, GA, IA, PA, UT, MA, CO|
|SPA Pending-Medicaid||HI (indefinite RAI)|
|Waiver approved for Adults||MA, AL|
|Waiver Pending for Adults|
|21 SPAs, 2 Waivers, 14 States|
SNAP & TANF
Net income, family size, income disregards for both
Alabama submitted two Medicaid ELE SPAs. One SPA that just did redetermination was approved on 11/2/09 and another SPA for initial determination and redetermination was approved on 6/7/10. Alabama’s waiver is for enrollment of parents into their family planning waiver population using ELE findings from SNAP and TANF.
All except alien/citizen status
While Iowa’s Medicaid program uses SNAP as the ELA, no children are enrolled in CHIP based on SNAP findings. Instead, when a child is denied Medicaid based on being over-income, the Medicaid findings and methodologies are accepted by CHIP for automatic enrollment.
NSLP (School Lunch)
SNAP - Income, SSN, age, residency, identity
NSLP-Income, age, residency, identity
Regular CHIP screen/enroll. The state auto-enrolls children based on information available.
Income, Budget unit, insurance, identity
State finds out from NSLP whether kids receive Free Lunch or reduced Lunch. If free lunch (under 130%FPL), kids are put on Medicaid. If reduced lunch, they are temporarily put on CHIP until more income information can be gathered.
Office of the Comptroller
Regular CHIP screen/enroll- Families indicate on their tax return that they are uninsured and the Comptroller sends list of all those under 300%FPL to the State agency, which sends out applications. State is in discussion with us now about how to move forward using income findings from the state tax data as well.
SNAP & NSLP
SNAP -Income, group size, SSN, residency NSLP–Income, household comp, residency
Screen/enroll- 30% points. SNAP recipients are sent a shortened Healthy Kids enrollment form one month after being found eligible for SNAP. School districts send lists of free lunch kids to OHA and OHA sends shortened Health Kids enrollment form
Income, identity, age and residency
Medicaid and CHIP both use findings from WIC enrollees with no insurance coverage. Families are sent a pre-populated application form for Medicaid/CHIP and may add other children in the family to the form as well.
SNAP & TANF
South Carolina is using income findings from the SNAP/TANF agency only at redetermination, for Medicaid enrollees who are also enrolled in SNAP or TANF. SC estimates this will greatly reduce churning off and on the program for children.
Colorado is using the National School Lunch income findings and using a 30% point screen and enroll option; at approval, 24 school districts were participating
Income, household size
Using SNAP income to keep families on at renewal if income is up to 150%FPL- using 30 Screen and Enroll to keep families on Medicaid, State will be able to use the same process for adults under their waiver authority
Dept of Taxation
At renewal, clients are mailed a consent form at renewal explaining their option to give consent to access their most current AGI from the Utah State Tax Commission instead of providing verification of each source of countable income for their family.
Income, household size, residency
New York’s ELE process relies on the use of findings from the CHIP agency at CHIP renewal to seamlessly enroll applicant children into Medicaid. This process alleviates the administrative burden associated with the two separate applications and verification processes in place for Medicaid and CHIP.
Income, household, resource methodologies
USVI is accepting SNAP income and household methodologies to send targeted enrollment letters to families, and enroll children when they receive affirmative consent.
Building an Express Lane Eligibility Initiative: A Roadmap of Key Decisions for States (PDF 269.72 KB), Kaiser Family Foundation and The Children’s Partnership, January 2010
Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Children Receive Medicaid and CHIP (PDF 2.51 MB), Urban Institute, April 2009
Express Lane Eligibility Toolkit , Children’s Partnership
“Why Express Lane Eligibility Makes Sense for States and Low-Income Families.” Children’s Partnership & Kaiser Family Foundation Report, October 2009.