Alabama Medicaid has taken the next step in modernizing the enrollment process by implementing a data-sharing initiative, called Express Lane Eligibility (ELE) to streamline and speed up the renewal process for Medicaid-eligible children. ELE lets Medicaid eligibility workers make eligibility redeterminations based on information already available through data systems of other state assistance programs.
“Express Lane Eligibility allows the state to ensure continued access to care, quality of care and better health outcomes for our beneficiaries while at the same time, making our operation more efficient,” said Alabama Medicaid Commissioner Carol H. Steckel.
The Agency implemented the new ELE process following approval of an amendment to Alabama Medicaid’s State Plan that went into effect Oct. 1, 2009. ELE allows Medicaid to use income eligibility determinations from other assistance programs to establish Medicaid eligibility for children who are on those programs at the time of the annual Medicaid eligibility review.
Authorized by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), the ELE tool improves administrative efficiency, and is another step in modernizing Medicaid’s enrollment system by taking advantage of data-sharing technology.
Once the system changes went into place, the Agency began implementing ELE statewide. Gretel Felton, Director of Medicaid’s Certification Support Division said, “The program is being implemented in stages. The approved State Plan amendment only allows ELE for renewals now, but we are about to request another amendment to that will also allow us to use ELE for applications. This second phase would begin March 1, 2010.
“We are very grateful for the high level of cooperation from Department of Human Resources in
working with us to implement this process. This is a collaborative effort with DHR as well as All Kids. If the ELE redetermination process establishes the recipient is not eligible, and over the Medicaid income limit, they will be automatically referred to All Kids.”
In this first phase, Medicaid eligibility workers conduct annual redetermination reviews relying on updated information and findings from DHR need-based programs such as TANF (Temporary Assistance for Needy Families) or SNAP (Supplemental Nutrition Assistance Program, formerly known as food stamps).
In the second phase of the program, eligibility workers will be able to process initial Medicaid
applications as well as renewals, and CHIP referrals using eligibility findings from DHR. In phase three, Medicaid envisions automatically updating the review using SNAP or TANF information for certain populations, and sending a letter notifying the family that the review was completed using available data. The family would need to notify the Agency only if they want to report changes. Eventually, the Agency will be able to use existing data to enroll new individuals automatically into Medicaid when they complete an application for SNAP or TANF.
ELE benefits the Agency and recipients. Agency eligibility workers no longer have to gather information already provided by the family to another public assistance program, thus simplifying the administrative process. For the family, the ELE process reduces the barriers to continued access to care for the children.