Academic journal article The Future of Children

Express Lane Eligibility

Academic journal article The Future of Children

Express Lane Eligibility

Article excerpt

Although great progress has been made in providing health coverage to low-income children, 9.2 million children remain uninsured. About 6.8 million of these children are eligible for public health insurance coverage. (1) (See the article by Holahan, Dubay, and Kenney in this journal issue.) Many of these uninsured children are enrolled in other public programs for low-income families that have eligibility requirements similar to those for public health insurance programs (Medicaid and the State Children's Health Insurance Program, or SCHIP). (2) Most low-income, uninsured children (63%, or 4.3 million) are concentrated in families that receive benefits through food stamps, the National School Lunch Program, or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). (3) The school lunch program alone reaches 3.7 million uninsured children, representing more than one-half of all low-income, uninsured children in the United States. (4) Therefore, targeting outreach to and simplifying health insurance enrollment for uninsured children enrolled in other public programs is both logical and efficient.

Programs like food stamps, WIC, and school lunch provide an obvious opportunity to link low-income children with health coverage. States could use eligibility information that families have provided to these programs as a basis for enrolling children in public health insurance coverage, but most states have no such system in place. Instead, families usually must visit multiple public agencies and submit duplicative information to each.

This article describes some states' creative strategies to increase children's enrollment in health insurance by connecting Medicaid and SCHIP with other public programs for low-income children and families. These strategies, referred to as "express lane eligibility" (ELE), (5) have the potential to significantly increase the number of low-income children with health insurance. The article begins with an overview of how ELE works, then assesses challenges facing ELE, and doses by offering several recommendations for how states can expand their use of ELE strategies.

Overview of ELE

States have used a variety of strategies to tackle the problem of high rates of uninsurance among children who participate in other public benefit programs. These strategies include targeted outreach, streamlined application processes, and automatic enrollment.

Targeted outreach uses other public programs as referral sources for finding, contacting, and providing application assistance to uninsured children who are eligible for Medicaid and SCHIP. This strategy has been used most widely with the school lunch program. The income-eligibility threshold for school lunch is more restrictive than that of most state public health insurance programs: To qualify for the school lunch program, children must live in families with incomes at or below 185% of the federal poverty level (FPL). Therefore, children eligible for school lunch often prove eligible for Medicaid or SCHIP as well. One example of targeted outreach through the school lunch program was recently implemented in Ohio (see Box 1 Targeted Outreach: Ohio's School Lunch Program).

Box 1

Targeted Outreach: Ohio's School Lunch Program

In 2001-2002, all Ohio public schools were required to include a
one-page health insurance addendum along with the school lunch
application sent to parents. The addendum asked families interested
in obtaining free or low-cost health care to complete and
return the form with the school lunch application. Schools then
sent these forms to the state, which mailed interested families an
application for Healthy Start, Healthy Families, the state's Medicaid
and SCHIP program. In Cincinnati, the public schools went further,
entering the information from the addendum into a database
that was then transferred to an outreach contractor for follow-up
and application assistance. … 
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