How Food Stamps Reduced Louisiana's Uninsured Children’s Rate

Louisiana was the first state to embrace “express lane eligibility."

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Louisiana, one of the poorest states in the nation, has one of the richest histories in covering its children with health insurance. The rate of uninsured children dropped from 5 percent to 3.5 percent during the past two years, a record low in the state and a big drop from the 11.1 percent rate just eight years earlier, according to a survey for the state’s Department of Health & Hospitals (DHH) by the Louisiana State University Public Policy Research Laboratory. Many factors have played a role in this success, including Louisiana’s early embrace of “express lane eligibility” (ELE).

The ELE option allows Louisiana Medicaid staff to collaborate with the Department of Children and Family Services (DCFS) to find children who are eligible for the Supplemental Nutrition Assistance Program (SNAP) and automatically enroll those who meet the Medicaid eligibility requirement. This reduces the need for applicants to submit enrollment paperwork twice for each program.

As the first state to adopt ELE, Louisiana enrolled more than 10,000 children into Medicaid in February 2010, based on SNAP data. And when that first group of ELE children came up for renewal, 92 percent of those who had used their SNAP cards retained Medicaid, an Urban Institute report found.

ELE not only saves clients headaches, it also saves the government time and money.

ELE-processed applications cost just $12 to $16, compared to $116 for traditionally processed applications. And ELE cost the state nothing to set up. The program was established with a $600,000 grant from the Robert Wood Johnson Foundation’s MaxEnroll project. That investment cut costs by an estimated $8 million to $12 million the first year, a return of investment between 15 and 22 to 1.

That’s not to say it was easy to roll out. “Technology is not a magic wand—a lot of work goes into making it operate,” says Ruth Kennedy, Louisiana’s Medicaid director. Even though DHH and DCFS already shared the vision and a working computer interface, it took a year or more to sift through the rules, test the analytics and work through the glitches.

In the middle of it all, the Centers for Medicare & Medicaid Services pushed through new procedural rules that replaced the opt-out requirement with an opt-in mandate. “We did lose some children during that change, and another challenge was that the DCFS was already in the middle of a major system overhaul, so their resources were drained,” says Diane Batts, acting Medicaid deputy director.

They plowed ahead, though. “Diane’s philosophy is that you don’t wait until everything is perfect before you implement. You do it in stages,” says Kennedy. Now, the interface processes applications daily and locates those children who might need closer eligibility evaluation for face-to-face review.

Integrating departments through technology has long been part of the state’s health and human services vision. “We already had legislation allowing us to use ELE before Congress approved it,” says Kennedy. “We anticipated the value of this back in 2007.”

Having an interface and a data exchange relationship between the agencies certainly helped Louisiana get off to a fast start. Since then, at least eight other states have begun implementing ELE, according to the Georgetown University Center for Children and Families. It likely wasn’t easy for them either, and it won’t be for other states looking to get into the express lane in the future. “It’s not simple,” Kennedy admits, “but the benefits are well worth what it takes to get you there.”

Caroline Cournoyer is GOVERNING's senior web editor.