Journal Issue: Health Insurance for Children Volume 13 Number 1 Spring 2003
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).
The strategy of streamlining applications goes a step further than targeted outreach by allowing the information a family has already provided to another public program to be used to evaluate a child's eligibility for Medicaid/SCHIP, or as a basis for recertification of eligibility. For example, Vermont has implemented a streamlining effort through WIC, and Los Angeles County has implemented a similar initiative through the food stamp program (see Box 2).
Beyond these two primary forms of ELE, the strategy that has the greatest potential benefit for children is automatic enrollment, which uses a child's enrollment in an income-comparable public program as a basis for qualifying that child as income-eligible for Medicaid or SCHIP. In California, for example, a new law will enable schools to use information from school lunch program applications to enroll children in the state's Medicaid program, a process that combines express lane and presumptive eligibility.6 (See Box 3.) Also called adjunctive eligibility, automatic enrollment is already in place in other programs. For instance, since 1989, WIC agencies have been able to accept an applicant's documented participation in Medicaid, food stamps, or Temporary Assistance for Needy Families (TANF) as evidence of income eligibility for WIC.7 Automatic enrollment has not been widely used in Medicaid and SCHIP, largely because it involves reconciling eligibility criteria for different programs and is therefore difficult to implement.8 Thus, while valuable progress has been made in streamlining enrollment processes, many challenges remain.