What Is Express Lane Eligibility?
Federal law [Section 1902(e)(13) of the federal Social Security Act (42 U.S.C. Sec. 1396a(e)(13)] gives states the option to base Medicaid and CHIP eligibility and renewal determinations on the specific findings of other need-based programs, such as the National School Lunch Program (NSLP), Supplemental Nutrition Assistance Program (SNAP), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), even where the other agency uses a different methodology to make that finding. This provision of the law relates only to children, but CMS has approved the use of ELE for parents as well, through the §1115 waiver.
ACA reinforces express lane principles by requiring states to employ cross-program, data-driven eligibility, and enrollment that minimizes burdens on individuals and families to the “maximum extent practicable.” [ACA, §1413] Also, it identifies the use of ELE (i.e., the borrowing of and reliance on findings and data from other programs) as a specific exception, or alternative, to the required use of “modified adjusted gross income” (MAGI) to determine income eligibility for health subsidy programs. [ACA, §2002]
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