Using Food Stamp Data to Implement ELE in

Louisiana

New CHIPRA Opportunity:Express Lane Eligibility

NASHP WebinarMay 14, 2009

J. Ruth KennedyLa. Dept of Health & Hospitals

The department, upon enactment by Congress of legislation allowing the same may utilize income determinations made by the Food Stamp Program, WIC, or National School Lunch Program for determining income eligibility for the Louisiana Medicaid program or LaCHIP.

La. R.S. 46:977.8

ELE is the Law in Louisiana!

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Why We Believe ELE is Important for Louisiana’s Kids

Highest % of state’s uninsured kids are from 50% to 100% FPL Literacy issues “Simplicity” of enrollment is relative Complicated lives

Different agencies determine Medicaid/CHIP and FS, WIC, and School Lunch eligibility Parental priorities Maslow’s hierarchy of needs

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Ex Parte Renewals Using Food Stamp Data Since 2001

High level of confidence in Food Stamp income data

Match with FS system identifies & flags children due for renewal with active FS case

Caseworkers still play major role in decision making

Income in FS system for Medicaid/CHIP income unit members is cross walked

~ 2/3 of Medicaid children are in active FS case Has resulted in dramatic reduction in procedural

(paperwork) closures

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Why Move from FS Ex Parte to FS ELE Renewals? Further reduction in administrative costs No longer a need for caseworker action Reduces our exposure to eligibility errors

True ELE cases excluded from QC and PERM Regardless of age kids over/under 100% FPL

eligible for Medicaid With Medicaid stimulus, higher FMAP for

Medicaid than CHIP thru 12/31/10! Performance bonuses based on Medicaid

increase

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Draft Plan for Automatic Enrollment Using ELA Data File of children <19 received from ELA We do file match with Medicaid and CHIP & remove

children with coverage File match through TPL contractor and remove

children with private insurance Mail required info about Medicaid and “call toll-free

number to activate” card During call, obtain any additional information to

certify case & certify case if eligible mother’s maiden name to verify citizenship via Vital Records Current income information

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State Plan Amendment is Required to Implement ELE

Cannot develop SPA without CMS guidance

Will CMS issue a template? What degree of detail will be

required? Once submitted, how quickly

can we expect approval?

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Decisions States Must Make

Selection and prioritization of Express Lane Agencies

ELE for Medicaid only or Medicaid and CHIP

ELE for applications, renewals, or both

Definition of ‘reasonable period” Eligibility components to be verified

via ELA Medicaid “screen and enroll”

threshold amount

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Express Lane Agency Issues

ELA application and renewal form must be revised Can addendum to application be used?

Willingness and capacity to modify their intake process

Additional ELA costs Forms revision Staff training System changes

Execution of data sharing agreement or MOU

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Coding Requirements and Implications CMS responsible for establishing

coding guidance Adequate data is essential for monitoring What we need to know--

Application or renewal? ELA classification/identity Demographics of ELE enrolled child Previously enrolled in public coverage? Automatic Enroll or something less? Number who “opt out

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Planning Ahead for the Mandated Evaluation Law requires evaluation of ELE to Congress by

9/30/12 $5 M (they’re serious about this) Lessons learned about evaluations

Keep notes of planning meeting Administrative cost data—traditional as well

as ELE Data, coding, back end reports

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Early ELE Implementation Hurdles in Louisiana

Only School Lunch application currently contain “opt out” language

Discovery of potential ELAs’ reliance on other program eligibility, rather than collecting income

SPA submission requires administrative rulemaking

Administrative rule making requires fiscal impact analysis

Fiscal impact analysis cannot be completed without CMS guidance

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ELE “Readiness” Activities in Louisiana

Request to FS agency for opt out language revision to forms

Identifying public agencies “capable” of determining income eligibility at 97% or higher rate of accuracy Collecting application forms Reviewing income policies

Determining data fields from ELA needed for fully Automated Enrollment

Annual volume estimates for both renewals and applications

Planning for eligibility review of ELE sample 13

Our Wish List from CMS (Sooner Rather than Later)

State Plan pages template Data and coding requirements Model language Guidance on full review for

statistically valid sample Definition of “prompt follow up” for

children temporarily enrolled in CHIP ELE-specific call with states (after

guidance is released)

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Ruth KennedyLaCHIP Director & Medicaid Deputy DirectorLouisiana Department of Health & HospitalsP.O. Box 91030 Baton Rouge, LA 70821-9030Telephone: 225 342 3032Blackberry: 225 241 1437Fax: 225 342 9508E-Mail: ruth.kennedy@la.gov www.lachip.org

Never doubt that a small group of thoughtful, caring people can change the world Indeed, it is the only thing that ever has !— Dr. Margaret Mead