Innovative strategies to enroll eligible people into Medicaid and CHIP SCI National Meeting Albuquerque, NM Stan Dorn  The...
Topics to discuss <ul><li>Express Lane Eligibility (ELE) under CHIPRA </li></ul><ul><li>Eligibility determination and enro...
Part I. Express Lane Eligibility under CHIPRA <ul><li>Rules </li></ul><ul><li>Three examples of how to use ELE - but many ...
ELE rules
Key ELE principles <ul><li>Basic idea : if another government agency has found a child to have a characteristic (e.g., inc...
Key limits and requirements  <ul><li>May not use ELE to establish citizenship. </li></ul><ul><ul><li>Can use for immigrati...
No CMS interpretation as yet <ul><li>But – no sanctions  if the state implements a reasonable interpretation of CHIPRA tha...
First example of ELE: state income tax forms CHIPRA specifically authorizes ELE based on gross income or adjusted gross in...
Uninsured children who qualify for Medicaid or CHIP, by legal requirement to file federal income taxes and eligibility for...
Among various groups of uninsured children, the estimated percentage whose families filed federal income tax returns: 2004...
What about  state  income taxes? <ul><li>Typically, state income tax returns are filed for a very large proportion of elig...
How state income tax ELE could work <ul><li>On tax form : </li></ul><ul><ul><li>Require parents to identify their uninsure...
How it could work, continued <ul><li>If child is not fully eligible based on ELE:  </li></ul><ul><ul><li>Family can comple...
Possible adjustments <ul><li>Prior-year tax data </li></ul><ul><ul><li>CHIPRA clearly permits – not a  legal  problem </li...
Second example of ELE: food stamps Note: Food stamps has been officially renamed the  Supplemental Nutrition Assistance Pr...
Background information on food stamps <ul><li>Income-eligibility:  Household must be at or below:  </li></ul><ul><ul><li>1...
How food stamp ELE could work <ul><li>Identify uninsured children </li></ul><ul><ul><li>Match food stamp eligibility files...
Third example of ELE: the National School Lunch Program (NSLP)
Background information on NSLP <ul><li>Practical issues   </li></ul><ul><ul><li>May not be feasible unless NSLP in your st...
How ELE could work with NSLP <ul><li>On NSLP application form, parents can: </li></ul><ul><ul><li>Identify any uninsured c...
NSLP-recipient children, by type of NSLP benefit and income-eligibility under standard Medicaid and CHIP rules (based on  ...
Part II. Eligibility determination and enrollment in Massachusetts Preliminary findings from a SHARE grant funded by the R...
Coverage expansion in Massachusetts  <ul><li>Extraordinary results . Only 2.6 percent of state residents were uninsured in...
Net increase in the number of Massachusetts residents with health insurance, by coverage type: 6/30/06 to 9/30/08  Source:...
How did Medicaid and CommCare enroll so many people? <ul><li>Generous subsidies , comprehensive benefits  </li></ul><ul><l...
Eligibility determination  <ul><li>A single application form  (Medical Benefit Request, or MBR) for all of the following: ...
Eligibility determination (continued) <ul><li>On-line application  form (MBR) </li></ul><ul><ul><li>A “virtual gateway” is...
Data-driven eligibility - rules <ul><li>Auto-conversion : Based on eligibility records for the state’s preexisting uncompe...
The effects of data-driven eligibility <ul><li>Huge initial impact  – generated more than 80% of all CommCare enrollment b...
Massachusetts is not paradise <ul><li>Government costs rose , because the formerly uninsured received subsidies. </li></ul...
Conclusion <ul><li>A key lesson of behavioral economics: lots of people won’t fill out forms, even if they and their famil...
Sources <ul><li>Express Lane Eligibility </li></ul><ul><li>Massachusetts </li></ul>Stan Dorn,  Express Lane Eligibility an...
Upcoming SlideShare
Loading in...5
×

Innovative strategies to enroll eligible people into Medicaid and CHIP

1,001

Published on

Presentation by Stan Dorn of The Urban Institute at the 2009 State Coverage Initiatives (SCI) Annual Meeting in Albuquerque, NM, July 30 2009.

Published in: Technology, Business
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,001
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
0
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Innovative strategies to enroll eligible people into Medicaid and CHIP

  1. 1. Innovative strategies to enroll eligible people into Medicaid and CHIP SCI National Meeting Albuquerque, NM Stan Dorn The Urban Institute [email_address] 202.261.5561 July 30, 2009
  2. 2. Topics to discuss <ul><li>Express Lane Eligibility (ELE) under CHIPRA </li></ul><ul><li>Eligibility determination and enrollment in Massachusetts </li></ul>
  3. 3. Part I. Express Lane Eligibility under CHIPRA <ul><li>Rules </li></ul><ul><li>Three examples of how to use ELE - but many other uses are also possible </li></ul>
  4. 4. ELE rules
  5. 5. Key ELE principles <ul><li>Basic idea : if another government agency has found a child to have a characteristic (e.g., income below a certain level) relevant to Medicaid or CHIP eligibility, the state health agency can use that finding to establish eligibility </li></ul><ul><li>Don’t sweat the small stuff : ELE is allowed even if eligibility methodologies differ between Medicaid/CHIP and the other program </li></ul><ul><li>Multiple uses : ELE can be used for both initial determination and redetermination </li></ul>
  6. 6. Key limits and requirements <ul><li>May not use ELE to establish citizenship. </li></ul><ul><ul><li>Can use for immigration status </li></ul></ul><ul><li>The other agency – the “Express Lane Agency,” or ELA – must: </li></ul><ul><ul><li>Provide the family with advance notice and a chance to “opt out” </li></ul></ul><ul><ul><li>Have an interagency agreement with the health agency </li></ul></ul><ul><li>May not use ELE to deny eligibility </li></ul><ul><ul><li>Standard procedures available as a back-up if ELE does not establish eligibility </li></ul></ul><ul><li>ELA finding must be within a “reasonable period,” as determined by state health agency </li></ul><ul><li>“ Screen and enroll” applies – however, 2 special options: </li></ul><ul><ul><li>Threshold approach . A state can set a threshold 30 FPL percentage points above the standard Medicaid eligibility limit. Based on whether the ELA says the child is above or below the threshold, the child goes into CHIP or Medicaid. </li></ul></ul><ul><ul><li>Temporary coverage . A state can temporarily enroll a child into Medicaid or CHIP, based on the child’s likely eligibility. The state then uses expedited procedures to determine the right program for the child (under standard Medicaid/CHIP eligibility rules). </li></ul></ul>
  7. 7. No CMS interpretation as yet <ul><li>But – no sanctions if the state implements a reasonable interpretation of CHIPRA that CMS later disapproves </li></ul><ul><li>Key questions for CMS include: </li></ul><ul><ul><li>1115 waivers to use ELE for parents </li></ul></ul><ul><ul><li>Definition of “error rate” </li></ul></ul><ul><ul><li>Whether the health agency (rather than the ELA) can satisfy the requirement to provide the family with an “opt out” notice </li></ul></ul><ul><ul><li>Access to enhanced FMAP for IT improvements via </li></ul></ul><ul><ul><ul><li>90/75 FMAP for SSA IT linkage (citizenship documentation) </li></ul></ul></ul><ul><ul><ul><li>MITA </li></ul></ul></ul><ul><ul><ul><li>ARRA </li></ul></ul></ul><ul><ul><ul><li>CHIPRA outreach grants </li></ul></ul></ul>
  8. 8. First example of ELE: state income tax forms CHIPRA specifically authorizes ELE based on gross income or adjusted gross income shown on state income tax returns and records
  9. 9. Uninsured children who qualify for Medicaid or CHIP, by legal requirement to file federal income taxes and eligibility for federal EITC: 2004 Source : Dorn, et al., Feb. 2009.
  10. 10. Among various groups of uninsured children, the estimated percentage whose families filed federal income tax returns: 2004 Sources : Dorn, et al., Feb. 2009.
  11. 11. What about state income taxes? <ul><li>Typically, state income tax returns are filed for a very large proportion of eligible, uninsured children. </li></ul><ul><ul><li>In IA, MD and NJ, hundreds of thousands of children have been identified as uninsured on state income tax forms. </li></ul></ul><ul><li>Consider: </li></ul><ul><ul><li>What’s your state’s minimum income threshold for required tax filing? Does it apply to gross income? </li></ul></ul><ul><ul><li>Does your state provide any refundable credits (e.g., an EITC or child care credit that supplements the federal credits)? </li></ul></ul><ul><ul><li>Remember —i f income is withheld from a paycheck, the worker may need to file a state tax return to get a refund </li></ul></ul>
  12. 12. How state income tax ELE could work <ul><li>On tax form : </li></ul><ul><ul><li>Require parents to identify their uninsured children – already done in IA, MD, NJ for children (MA for adults) </li></ul></ul><ul><ul><li>Let parents request disclosure of tax data to the health agency </li></ul></ul><ul><ul><ul><li>Very important step . Without it, parents must file 2 forms, income tax form and a later health coverage form. May never file the second. </li></ul></ul></ul><ul><ul><ul><ul><li>In Iowa, the state mailed application forms to parents who identified their children as uninsured — o nly 10% applied.* With low-income people, direct mail has never yielded a high response rate . </li></ul></ul></ul></ul><ul><li>Grant income-eligibility based on gross income (or AGI) and household size as shown on the income tax return </li></ul><ul><li>Qualify children as citizens based on SSA data match </li></ul><ul><li>Determine immigration status for non-citizens </li></ul><ul><ul><li>Intensive application assistance to obtain immigration evidence </li></ul></ul><ul><ul><ul><li>Can obtain in the enrollment phase (will discuss in a moment) </li></ul></ul></ul><ul><ul><ul><li>Until final enrollment, grant presumptive eligibility (PE) based on income </li></ul></ul></ul><ul><ul><li>Possible ELE based on SSA determination of legal residence when issuing SSN </li></ul></ul>*In 2009, IA passed a law mandating the completion of Medicaid/CHIP application forms when parents identify their children as uninsured on their tax returns. No enforcement is planned as yet.
  13. 13. How it could work, continued <ul><li>If child is not fully eligible based on ELE: </li></ul><ul><ul><li>Family can complete the relevant portion of the standard application form to address the missing eligibility requirements </li></ul></ul><ul><ul><li>Normal rules determine whether those requirements are met </li></ul></ul><ul><li>Collecting any remaining paperwork </li></ul><ul><ul><li>Can direct families to on-line forms </li></ul></ul><ul><ul><ul><li>CHIPRA allows electronic signature </li></ul></ul></ul><ul><ul><li>Can use CBOs, facilitated enrollers </li></ul></ul><ul><ul><li>In a managed care state, can collect documents during enrollment, using managed-care organizations (MCOs) </li></ul></ul><ul><ul><ul><li>Let the family pick an MCO </li></ul></ul></ul><ul><ul><ul><li>If the family doesn’t act, the state chooses an MCO </li></ul></ul></ul><ul><ul><ul><li>Once the MCO has been chosen, the MCO must collect the final paperwork before capitated payments start </li></ul></ul></ul><ul><ul><ul><ul><li>Key: no MCO contact with family until a plan is chosen </li></ul></ul></ul></ul>
  14. 14. Possible adjustments <ul><li>Prior-year tax data </li></ul><ul><ul><li>CHIPRA clearly permits – not a legal problem </li></ul></ul><ul><ul><li>Ample federal precedent: Medicare Part B premium subsidies, 2008 stimulus payments, federally-subsidized college student aid </li></ul></ul><ul><ul><ul><li>Prior-year tax forms determine eligibility for current-year subsidies </li></ul></ul></ul><ul><ul><ul><li>If income lower this year, can immediately apply for higher subsidies </li></ul></ul></ul><ul><ul><ul><li>If income higher this year, subsidies not affected until a future year </li></ul></ul></ul><ul><ul><li>For policy reasons, a state might: </li></ul></ul><ul><ul><ul><li>adjust prior-year tax information based on more recent quarterly earnings data (via IEVS or National Directory of New Hires) </li></ul></ul></ul><ul><ul><ul><li>limit the application of ELE if a new hire is reported or if the prior-year tax return shows significant non-W-2 income </li></ul></ul></ul><ul><li>Self-employment income </li></ul><ul><ul><li>For tax purposes, can deduct from even gross income </li></ul></ul><ul><ul><ul><li>Meals; </li></ul></ul></ul><ul><ul><ul><li>Entertainment; </li></ul></ul></ul><ul><ul><ul><li>Depreciation; etc. </li></ul></ul></ul><ul><ul><li>Could add back these deductions in calculating gross income or adjusted gross income, for purposes of ELE </li></ul></ul>
  15. 15. Second example of ELE: food stamps Note: Food stamps has been officially renamed the Supplemental Nutrition Assistance Program, or SNAP
  16. 16. Background information on food stamps <ul><li>Income-eligibility: Household must be at or below: </li></ul><ul><ul><li>100 percent FPL in net income (using food stamp disregards); and </li></ul></ul><ul><ul><li>130 percent FPL in gross income </li></ul></ul><ul><li>Impact . 12.4 percent of eligible, uninsured children received food stamps in 2004. Dorn, et al., April 2009. </li></ul><ul><li>Administrative ease . Most Medicaid agencies already have access to food stamp eligibility files. </li></ul><ul><li>Huge efficiency gains . Almost no value is added by requiring a separate health application. </li></ul><ul><ul><li>Among uninsured food-stamp children, fewer than 1 percent are ineligible for Medicaid and CHIP, under standard rules for health coverage. Dorn, et al., April 2009. </li></ul></ul><ul><ul><ul><li>Note: Statistic applies (a) in states that extend Medicaid and CHIP to recently arrived immigrant children and (b) in other states, to U.S.-citizen children. </li></ul></ul></ul>
  17. 17. How food stamp ELE could work <ul><li>Identify uninsured children </li></ul><ul><ul><li>Match food stamp eligibility files with Medicaid and CHIP files to identify food stamp children not receiving health coverage </li></ul></ul><ul><ul><li>Permitted by pre-CHIPRA food stamp law </li></ul></ul><ul><li>Let parents opt out </li></ul><ul><ul><li>Send notice explaining that, unless they object, data from their children’s food stamp files will be used to determine potential eligibility for health coverage </li></ul></ul><ul><li>Determine eligibility </li></ul><ul><ul><li>Automatically find, via ELE, that </li></ul></ul><ul><ul><ul><li>All food stamp children are income-eligible for Medicaid; </li></ul></ul></ul><ul><ul><ul><li>All immigrant food stamp children are legally residing in the U.S., for purposes of Medicaid </li></ul></ul></ul><ul><ul><ul><ul><li>Maybe not in a state with a 5-year bar for newly arrived immigrants </li></ul></ul></ul></ul><ul><ul><li>Establish citizenship via SSA data-match </li></ul></ul><ul><li>Parents must consent before enrollment </li></ul><ul><li>Use ELE at renewal </li></ul><ul><ul><li>If child receives food stamps, automatically continue income-eligibility for Medicaid, without any need to analyze food stamp records in terms of Medicaid rules </li></ul></ul>
  18. 18. Third example of ELE: the National School Lunch Program (NSLP)
  19. 19. Background information on NSLP <ul><li>Practical issues </li></ul><ul><ul><li>May not be feasible unless NSLP in your state has matchable, centralized eligibility data </li></ul></ul><ul><ul><li>Can you implement statewide? Or must you go district-by-district? </li></ul></ul><ul><ul><li>What incentives apply to schools? Can some school aid be alotted based on Medicaid/CHIP enrollment, as happens in Illinois? </li></ul></ul><ul><li>Broad reach — Dorn and Kenney, 2006, found that NSLP families include: </li></ul><ul><ul><li>59% of all uninsured children under 200% FPL </li></ul></ul><ul><ul><li>56% of uninsured citizen children under 200% FPL </li></ul></ul><ul><li>NSLP eligibility </li></ul><ul><ul><li>Free lunch: 130% FPL, gross income </li></ul></ul><ul><ul><li>Reduced-price lunch: 185% FPL, gross income </li></ul></ul><ul><ul><li>No immigration status restrictions </li></ul></ul>
  20. 20. How ELE could work with NSLP <ul><li>On NSLP application form, parents can: </li></ul><ul><ul><li>Identify any uninsured children; and </li></ul></ul><ul><ul><li>Consent to disclose NSLP and other data to determine children’s eligibility for free or reduced-cost health coverage </li></ul></ul><ul><li>If children receive free lunches, use ELE to automatically qualify them as income-eligible for Medicaid </li></ul><ul><li>If children receive reduced-price lunches, either </li></ul><ul><ul><li>Use NSLP income-determination to establish income-eligibility for Medicaid/CHIP or </li></ul></ul><ul><ul><li>Provide PE and target children for intensive assistance to establish ongoing eligibility </li></ul></ul><ul><li>For anything beyond PE, Medicaid/CHIP procedures must establish citizenship or status as a legally resident immigrant </li></ul><ul><li>Collection of remaining paperwork </li></ul><ul><ul><li>Can follow income tax approach </li></ul></ul>
  21. 21. NSLP-recipient children, by type of NSLP benefit and income-eligibility under standard Medicaid and CHIP rules (based on audited family income) Source : Dorn, April 2009. Children receiving free school lunches Children receiving reduced-price school lunches Income-eligible for Medicaid 81% 49% Income-eligible for CHIP 14% 38% Income too high for both programs 4% 13% Total: 100% 100%
  22. 22. Part II. Eligibility determination and enrollment in Massachusetts Preliminary findings from a SHARE grant funded by the Robert Wood Johnson Foundation
  23. 23. Coverage expansion in Massachusetts <ul><li>Extraordinary results . Only 2.6 percent of state residents were uninsured in 2008 – the lowest percentage ever recorded in any state </li></ul><ul><ul><li>From 6/06 to 9/08, the number of insured rose by 432,000 </li></ul></ul><ul><li>Well-known policy changes adopted in 2006 </li></ul><ul><ul><li>Subsidies up to 300% FPL, through Medicaid and a new program, called Commonwealth Care (CommCare) </li></ul></ul><ul><ul><li>All adults mandated to purchase coverage </li></ul></ul><ul><ul><ul><li>Exception for those unable to afford coverage </li></ul></ul></ul><ul><ul><ul><li>Enforced through state income tax system </li></ul></ul></ul><ul><ul><li>Health insurance exchange (the “Connector”) has multiple private plans for people not offered employer-sponsored insurance </li></ul></ul>
  24. 24. Net increase in the number of Massachusetts residents with health insurance, by coverage type: 6/30/06 to 9/30/08 Source: Massachusetts Division of Health Care Finance and Policy, February 2009.
  25. 25. How did Medicaid and CommCare enroll so many people? <ul><li>Generous subsidies , comprehensive benefits </li></ul><ul><li>Massive PR campaign about subsidies and the mandate </li></ul><ul><ul><li>The mandate was important in getting people’s attention, even among those against whom it was not enforced (adults under 150% FPL). This group includes: </li></ul></ul><ul><ul><ul><li>73% of CommCare enrollees </li></ul></ul></ul><ul><ul><ul><li>All Medicaid adults </li></ul></ul></ul><ul><ul><li>Behavioral economics research shows that “avoiding a problem” motivates people much more than “gaining a benefit” – even if the two are logically identical! </li></ul></ul><ul><li>Community-based organizations (CBOs) received $2.5-$3.5 million in annual outreach and enrollment mini-grants </li></ul><ul><ul><li>Long before 2006 legislation </li></ul></ul><ul><ul><li>CBOs trusted in low-income communities </li></ul></ul>
  26. 26. Eligibility determination <ul><li>A single application form (Medical Benefit Request, or MBR) for all of the following: </li></ul><ul><ul><li>Medicaid </li></ul></ul><ul><ul><li>CHIP </li></ul></ul><ul><ul><li>CommCare </li></ul></ul><ul><ul><li>State-funded program for immigrant children </li></ul></ul><ul><ul><li>Uncompensated care payments to safety net hospitals and community health centers </li></ul></ul><ul><li>A single agency - Medicaid - determines eligibility for all of those programs </li></ul><ul><ul><li>One statewide unit (regional offices do renewals, follow-up) </li></ul></ul><ul><ul><li>Logic-driven and computerized, not worker-driven </li></ul></ul><ul><ul><li>Common eligibility methodologies for all programs </li></ul></ul><ul><li>Integrated eligibility determination prevents consumers from falling through the cracks between programs </li></ul>
  27. 27. Eligibility determination (continued) <ul><li>On-line application form (MBR) </li></ul><ul><ul><li>A “virtual gateway” is accessible to trained and deputized staff of providers and CBOs </li></ul></ul><ul><ul><li>The on-line MBR is structured to prevent many errors. This results in faster and less costly processing by the state. </li></ul></ul><ul><li>Provider or CBO becomes the applicant’s authorized representative . The representative receives a copy of all eligibility-related state notices (e.g., asking for more information). </li></ul><ul><ul><li>Key to effective follow-though </li></ul></ul><ul><li>The MBR must be properly completed for a hospital or clinic to obtain full reimbursement , whether or not the patient ultimately qualifies for Medicaid or CommCare </li></ul><ul><ul><li>Incentive to fill out forms for consumer, help gather documents </li></ul></ul><ul><ul><li>State does not pay providers for this work </li></ul></ul><ul><li>Major efficiency gains – roughly doubled caseload while increasing state administrative staff less than 10%. </li></ul><ul><ul><li>But there were up-front transition costs, both financial and cultural </li></ul></ul><ul><li>Timing : These administrative reforms long preceded the 2006 legislation </li></ul>
  28. 28. Data-driven eligibility - rules <ul><li>Auto-conversion : Based on eligibility records for the state’s preexisting uncompensated care pool, Medicaid automatically qualified people for CommCare, without any need for applications </li></ul><ul><li>Enrollment into MCOs: </li></ul><ul><ul><li>After receiving notice of CommCare eligibility, people had a brief interval in which to pick an MCO </li></ul></ul><ul><ul><li>If no MCO was chosen, and the person qualified for premium-free CommCare, the person was auto-assigned to an MCO </li></ul></ul><ul><ul><ul><li>Under 100% FPL, 48,000 auto-assigned in late 2006 </li></ul></ul></ul><ul><ul><ul><li>100-150% FPL, approximately 15,000 auto-assigned in late 2007* </li></ul></ul></ul><ul><li>If an eligible consumer neither chooses nor is auto-assigned to an MCO , what happens when the consumer seeks care? </li></ul><ul><ul><li>The provider checks on-line and sees that the consumer is eligible but not enrolled </li></ul></ul><ul><ul><li>The provider urges consumer to enroll, choose plan, pay premium </li></ul></ul><ul><ul><li>Provider not fully reimbursed, unless visit within 90 days of auto-conversion </li></ul></ul>*Some of these auto-assignees had self-initiated applications, were found eligible, but did not select a plan.
  29. 29. The effects of data-driven eligibility <ul><li>Huge initial impact – generated more than 80% of all CommCare enrollment by the program’s sixth month (May 2007) </li></ul><ul><li>Lowered premiums </li></ul><ul><ul><li>Auto-assigned members use less care, so desirable to MCOs </li></ul></ul><ul><ul><li>Leverage with MCOs: low bidders get more auto-assigned members </li></ul></ul><ul><li>Simplified enrollment by eliminating the need to complete and process application forms </li></ul><ul><ul><li>100-300% FPL – 62,000 were auto-converted to CommCare. Not yet known how many chose an MCO and enrolled. </li></ul></ul><ul><ul><li>Compared to requiring standard application forms, less costly for providers, CBOs, and state </li></ul></ul><ul><li>Consumers were more likely to enroll without the need to complete application forms. </li></ul><ul><li>Fits with other state policies that encourage trained private entities to complete applications on behalf of consumers, via “virtual gateway” </li></ul><ul><ul><li>State policy gave providers the necessary incentives </li></ul></ul><ul><ul><li>Grants gave mission-driven CBOs the necessary resources </li></ul></ul>
  30. 30. Massachusetts is not paradise <ul><li>Government costs rose , because the formerly uninsured received subsidies. </li></ul><ul><li>A few administrative glitches remain. For example: </li></ul><ul><ul><li>Churning . At renewal, many members lose coverage because they fail to complete and return redetermination forms. They frequently return to the program within months. </li></ul></ul><ul><ul><li>Movement from Medicaid to CommCare . When members go from Medicaid to CommCare, coverage is often interrupted. CommCare does not begin until the first of the month, but Medicaid begins and ends at any time. </li></ul></ul><ul><ul><li>The state’s integrated eligibility system leaves out one program , which covers the recently unemployed. That program uses different applications, different eligibility methodologies, and has eligibility determined by a different agency. As a result, uninsured consumers eligible for subsidies sometimes go months without coverage as they move from the integrated eligibility system into this other program. </li></ul></ul>
  31. 31. Conclusion <ul><li>A key lesson of behavioral economics: lots of people won’t fill out forms, even if they and their families would benefit. </li></ul><ul><ul><li>Not just low-income people. The classic studies involve middle-income people failing to participate in 401(k) plans. </li></ul></ul><ul><li>ELE uses existing data to establish eligibility, eliminating the need for consumers to complete largely redundant application forms. </li></ul><ul><li>Massachusetts: </li></ul><ul><ul><li>Used existing data to establish eligibility, in many cases </li></ul></ul><ul><ul><li>Engaged safety net providers and CBOs to play a major role helping consumers through the application process </li></ul></ul><ul><ul><li>Used a single, integrated eligibility system for multiple programs, thereby simplifying enrollment and often making it seamless </li></ul></ul><ul><li>Such innovative strategies can: </li></ul><ul><ul><li>Increase participation by eligible consumers </li></ul></ul><ul><ul><li>Lower state administrative costs </li></ul></ul><ul><ul><li>Cut red tape for families </li></ul></ul><ul><ul><li>Reduce errors by using data matches and trained application assisters to establish eligibility, rather than consumer-completed (and manually processed) traditional application forms </li></ul></ul>
  32. 32. Sources <ul><li>Express Lane Eligibility </li></ul><ul><li>Massachusetts </li></ul>Stan Dorn, Express Lane Eligibility and Beyond: How Automated Enrollment Can Help Eligible Children Receive Medicaid and CHIP , prepared by the Urban Institute for the Robert Wood Johnson Foundation and the National Academy for State Healthy Policy, April 2009. Stan Dorn, Bowen Garrett, Cynthia Perry, Lisa Clemans-Cope, and Aaron Lucas, Nine in Ten: Using the Tax System to Enroll Eligible, Uninsured Children into Medicaid and SCHIP, prepared by the Urban Institute for First Focus, February 2009. Stan Dorn and Genevieve Kenney, Automatically Enrolling Eligible Children and Families Into Medicaid and CHIP: Opportunities, Obstacles, and Options For Federal Policymakers , prepared by the Economic and Social Research Institute and the Urban Institute for The Commonwealth Fund, June 2006. Massachusetts Division of Health Care Finance and Policy, Health Care in Massachusetts: Key Indicators , February 2009. Stephanie Anthony, Robert W. Seifert, Jean C. Sullivan, The MassHealth Waiver: 2009-2011…and Beyond , prepared by the Center for Health Law and Economics, University of Massachusetts Medical School, for the Massachusetts Medicaid Policy Institute and the Massachusetts Health Policy Forum, February 2009. The Massachusetts Health Insurance Connector Authority, Report to the Massachusetts Legislature: Implementation of the Health Care Reform Law, Chapter 58, 2006-2008 , October 2008. Note: much of the presentation’s discussion of Massachusetts reforms is based on a site visit to Massachusetts, which was part of Urban Institute research conducted through a grant under the State Health Access Reform Evaluation program (SHARE). SHARE is funded by the Robert Wood Johnson Foundation, with the State Health Access Data Assistance Center serving as the national program office. Together with state administrative data, findings from the site visit will be published shortly.

×