The Kaiser Commission on Medicaid and the Uninsured has released two policy reports on Express Lane Eligibility (ELE), entitled: "Why Express Lane Eligibility Makes Sense for States and Low-Income Families" and "Express Lane Eligibility Efforts: Lessons Learned from Early State Cross-Program Enrollment Initiativest."

From the summary:

Express Lane Eligibility (ELE) is a new tool available to states to streamline enrollment and renewal of children in Medicaid and CHIP.  It allows state Medicaid and CHIP agencies to utilize data and eligibility findings from other public need-based programs, such as Head Start or Food Stamps, and/or tax return data to identify, enroll and recertify children rather than requiring them to re-analyze and determine eligibility under their own rules.

A primary goal of this and other outreach and simplification initiatives authorized by the Children's Health Insurance Program Reauthorization Act of 2009 is to reach the 7 in 10 uninsured children who are already eligible for Medicaid and CHIP.  The briefs in this series, which are jointly produced by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured and The Children’s Partnership, provide an overview of Express Lane Eligibility and examine key issues related to implementing an ELE initiative.

The Kaiser Family Foundation. (2009). Putting children on the express lane to health insurance: streamlining enrollment and renewal of children in Medicaid and CHIP through express lane eligibility. The Kaiser Commission on Medicaid and the Uninsured.

Full reports: http://www.kff.org/medicaid/kcmy103009pkg.cfm

This toolkit, created by CHCS’ Collaborative on Improving Managed Care Quality for Youth with Serious Behavioral Health Needs, offers best practices implemented by managed care organizations (MCOs), challenges and lessons learned, and opportunities for continued innovations in care for children and youth with serious behavioral health needs.

From CHCS:

Although Medicaid managed care programs are covering children with serious behavioral health disorders, limited funds for program evaluation have prevented most from examining their impact on children’s behavioral health care. The 10-year, SAMHSA-funded Health Care Reform Tracking Project found that in roughly 45% of Medicaid managed care programs, the impact of managed care on children’s behavioral health care (e.g., service utilization, quality, cost, and family satisfaction) was unknown, and in 63% of programs, impact on clinical and functional outcomes was unknown. Notably, SAMHSA found that the Medicaid fee-for-service system did not provide such data either. 16 This Collaborative provided a timely opportunity for participating MCOs to look more closely at their data for this population, and develop new data to inform and track quality enhancements.

Center for Health Care Strategies, Inc. (2009). Improving Medicaid managed care for youth with serious behavioral health needs: a quality improvement toolkit. Kamala Allen and Sheila A. Pires.

Full toolkit: http://www.chcs.org/usr_doc/Improving_Medicaid_Managed_Care_for_Youth_with_Serious_Behavioral_Health_Needs_Toolkit.pdf

This Kaiser Family Foundation brief compares the Medicaid and Children's Health Insurance Program (CHIP) provisions in the House Tri-Committee, America’s Affordable Health Choices Act and the Senate Finance America’s Healthy Future Act to current law, highlighting major differences in Medicaid coverage and financing, maintenance of eligibility, benefits and access and CHIP.

From the report:

A provision in the House bill that would have fully financed the Medicaid expansions with federal funds was amended to replace full federal financing with 90% federal financing beginning in year 2015. Under the Senate proposal, states will receive a 23 percentage point increase in the CHIP match rate up to a cap of 100% and a 15 percentage point increase in the Medicaid match rate beginning in 2013 to help pay for the MOE for children.  States would also receive assistance in financing the costs of the Medicaid expansion through a percentage point increase in the FMAP. The percentage point increase in the FMAP would be 27.3 for “expansion” states that already cover adults with incomes above 100% FPL and 37.3 for other states. These percentage point increases will be adjusted over time so that by 2019, all states will receive an FMAP increase of 32.3 percentage points for the newly eligible (up to a cap of 95% in any year). Certain “high-need” states (those with total Medicaid enrollment that is below the national average for enrollment as a percentage of the state population on enactment and adjusted unemployment rates of 12% or higher for August 2009) could qualify for full federal financing for expansions for 5 years. States would be required to pay an amount equal to the state’s average cost for Medicaid (by eligibility category) for those opting to enroll in the exchange.

Kaiser Family Foundation. (2009). Medicaid and Children’s Health Insurance Program provisions: America’s Affordable Health Choices Act & America’s Healthy Future Act.

Full report: http://www.kff.org/healthreform/upload/7952.pdf

This report from the Kaiser Family Foundation examines the health care needs and costs of children, profiling two particular children. 

From the report:

As health reform discussions continue, one key topic that will need to be addressed is what will be included in the coverage provided and how well it will meet individuals’ health care needs.  Because they are growing and developing, children have a distinct set of health care needs that evolve over time and differ from those of adults. Moreover, while as a group children are relatively healthy, one in seven has special health care needs.  Given that under reform, many children will be covered through private plans and some children who are currently covered through public programs may be shifted to private plans, it is particularly important to consider how well private plans might meet children’s health care needs. A key question for children is what coverage standards will be applied to these private plans under reform.

To examine how well a generous private plan today addresses the varying health needs of  children, this brief analyzes the specific health care needs of two children, including:

• Jacob, a 7-year-old boy who is in generally good health but suffers from the relatively common ailments of asthma and allergies; and
• Isabel, a 13-year-old girl who was born prematurely and has cerebral palsy and requires a broad range of acute and long-term services and supports that enable her to function and learn at school.

Profiles of the health care utilization of these children during the last year were developed through interviews with their parents. Their actual utilization was then compared to the benefit coverage and cost-sharing requirements of the Blue Cross Blue Shield Standard Option (BCBSSO) plan to determine which of their services would be covered and what their families would pay both in cost-sharing and for non-covered services. The BCBSSO is the most popular coverage option offered through the Federal Employees Health Benefits Program (FEHBP) and is similar in many respects to coverage offered by other large employers. Overall, it is generous in terms of the benefits covered, but it charges relatively significant cost-sharing. The analysis also considers what coverage these children would receive and the costs their families would pay under Medicaid’s EPSDT benefit package, which is specifically designed for children with low incomes and/or high health needs. 

Kaiser Family Foundation. (2009). Children and health care reform: assuring coverage that meets their health care needs. Alker, Joan, Pollitz, Karen, Wachino, Victoria, Libster, Jennifer, and Paradise, Julia. 

Full report: http://www.kff.org/healthreform/upload/7980.pdf 

This study found that the Communities That Care (CTC) prevention program significantly reduced alcohol and tobacco use as well as delinquent behavior. 

Hawkins, J.D., Oesterle, S., Brown, E. C. et al. (2009). Results of a type 2 translational research trial to prevent adolescent drug use and delinquency. Archives of Pediatrics and Adolescent Medicine. 163(9), 789-798. http://archpedi.ama-assn.org/cgi/content/abstract/163/9/789 

Authors: J. David Hawkins, Sabrina Oesterle, Eric C. Brown, Michael W. Arthur, Robert D. Abbott, Abigail A. Fagan, Richard F. Catalano. 

This National Academy for State Health Policy report highlights key aspects of BadgerCare Plus, Wisconsin’s innovative health insurance program, that may be helpful for other states as they seek new ways to extend health care coverage.

From the report:

Similar to proposed federal reforms, BadgerCare Plus operates as a system that builds on Medicaid and CHIP while also supporting employer-sponsored insurance. Medicaid and CHIP programs do not operate in isolation, so it is important for states to consider how these programs interact with employer-sponsored insurance plans and the remaining components of the health care financing sector. In Wisconsin, individuals and families eligible for either Medicaid or CHIP enroll in BadgerCare Plus, and do not need to know which program funds their health insurance. In addition, families above 300% FPL can buy into the CHIP program. Enrollees do not need to apply separately for Medicaid and CHIP; instead, BadgerCare Plus enrolls each beneficiary in the appropriate program.

National Academy for State Health Policy (2009). BadgerCare Plus Program: Medicaid and subsidies under one umbrella. Witgert, Katharine E.

Full report: http://www.rwjf.org/files/research/47472brief.pdf