How much does it cost the state to enroll kids in Medicaid and CHIP? I don’t know what it is in Texas, but last week I got a glimpse of what it cost in Louisiana, and I’m thinking it’s not much different here. Maybe higher.
Last week, the Urban Institute released the most in-depth analysis that I’d seen of a state improving its enrollment process for children on Medicaid. The 30-page report showed how Louisiana hit a home run when it became the first state to implement automatic enrollment processes called Express Lane Eligibility. Essentially. the state married technology and policy changes to get more kids insured.
The policy change was simple. The state looked at what families with uninsured kids were getting food stamps, and they sent those parents Medicaid cards for the kids. They told them that all they had to do was use the cards to be enrolled. Here’s where the costs come in. According to the report, Louisiana was spending an average of $116.48 to process a children’s Medicaid application. Through the Express Lane process, the cost dropped to between $12 and $15. Right off the bat, the state saved $1.1 million on enrollment costs during the first year.
Yet, the biggest savings were in renewals. Louisiana said it cost $76 in administrative costs per child for each renewal. By automatically deeming children who were getting food stamps for Medicaid eligibility, the cost dropped to zero, saving the state more than $8 million. Total return on investment for buying the technology necessary: between 15 and 22 to 1 after one year. And get this: procedural terminations now affect less than 1% of children in Medicaid and Louisiana’s CHIP program, LaCHIP. Fewer than 5% lose coverage for any reason. Compare this to the national average — 29% of Medicaid and CHIP children lose coverage at renewal, even though 44% of the terminated children continue to qualify. That means there are gaps in coverage as families fall through administrative cracks.
Now, think about Texas. We’ve got twice the renewal costs because families have to renew every 6 months. In Louisiana, it’s every 12 months. And the administrative costs might also be higher here because we have an asset test, which Louisiana doesn’t have. But aside from costs, here’s the best news: more kids found coverage. “Through these and other measures, Louisiana reduced the proportion of its low-income children without coverage from 25.5% in 1997-1998—the 15th-highest state percentage in the U.S.— to 11.8% in 2009-2010—the 21st-lowest state percentage, according to Census Bureau data. Put differently, the state moved from having one of the country’s highest proportions of uninsured low-income children to better than the national mid-point.”
After these changes, the state conducted focus groups with families. So, when they asked parents what they thought when they received coverage for their children even though they hadn’t applied, here were some of the responses:
“I thought it was a gift from God!”
“I said thank you, God!”
”I was jumping for joy.”
Since Louisiana implemented this, other states followed suit: Georgia, Iowa, New Jersey, and Pennsylvania. In addition, Arizona, Colorado, and Massachusetts all have plans to implement Express Lane Eligibility.
Read the entire report here.
Enrollment up in February
Enrollment in children’s Medicaid and CHIP was up in February. For Tarrant County:
- Enrollment in children’s Medicaid was 149,935, up by 1,294 kids over January.
- Enrollment in CHIP was 41,138, up by 413 kids.
- Over the past year, enrollment has grown 6.5%. We continue to outpace state growth, which is up 4.5% over the past year.
I don’t know if this is a blip or not, but the state numbers saw an unusual trend in February. There were more new enrollments in CHIP (4,198) than children’s Medicaid (3,114) . Generally, children’s Medicaid enrollments outnumber CHIP by about 5 to 1.
Maybe all the new dental ads are spurring more working families to get their kids insured. Awareness is good!