Scalable Innovation | Express Lane Eligibility Case Study

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The Children’s Partnership envisions a world in which every child, no matter their background, has the resources and opportunities they need for a bright future. To make that vision a reality, we leverage our technical policy knowledge in California to influence federal policies and take our demonstrated solutions to scale to reach as many kids as possible.

Following the passage of the Children’s Health Insurance Program in 1997, extensive effort went into enrolling the millions of eligible but uninsured children into coverage. In 1999, TCP published a report that presented a new and simplified approach to enrolling children into public coverage options, which was coined Express Lane.

Express Lane refers to the concept of relying on findings, for things like income, household size, or other factors of eligibility, from another public program to facilitate enrollment in health coverage. Programs may include: SNAP (food stamps), School Lunch, TANF, Head Start, and the Supplemental Nutrition Program for Women, Infants, and Children (WIC). This solution was a response to the fact that in California and across the nation, the majority of children applying for health coverage were already enrolled in other public programs with similar eligibility requirements to those needed to qualify for health insurance.

Working with stakeholders, TCP helped design and championed the passage of legislation authorizing an Express Lane pilot program (named “Express Enrollment”) in California. From 2003, TCP provided technical support to over 100 schools, including schools in the Los Angeles Unified School District, to implement this pilot program that allowed for School Lunch applications to serve as the beginning of a Medi-Cal application.

While the program enrolled some children in health coverage, reflection and independent evaluations helped TCP identify key barriers that prevented the pilot from being as successful as had been hoped. Chief amongst these barriers were key information technology limitations as well as the need for greater flexibility in federal Medicaid policy. With these important lessons and a strong case for this streamlined enrollment process in hand, TCP and fellow advocates began working with members of Congress to draft legislation addressing these issues and extending authority for Express Lane to states across the country. With the signing of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) in 2009, federal policy approved Express Lane as a possible tool for states to use to enroll eligible children in Medicaid and CHIP. Today, more than a dozen states use the strategy.

From idea to an on-the-ground test case in California to inclusion in federal legislation a decade later in Congress, TCP leveraged its innovative thinking to bring its high-impact solution to scale for children across the country.

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