CHIP Administration & Eligibility

Template CS32 – General Eligibility - Express Lane Eligibility

Statute: Sections 2107(e)(1)(E) and 1902(e)(13) of the SSA

Regulation:

Additional Reference: SHO # 10-003, February 4, 2010

INTRODUCTION

To be completed by States with separate child health assistance programs.

In template CS32, States indicate if they elect the option to use Express Lane agencies to determine whether a child meets one or more of the requirements for CHIP eligibility and if yes, provide information as to how Express Lane will be administered.

BACKGROUND

Express Lane Eligibility was enacted as part of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). It permits states to use the findings of other public agencies to conduct simplified eligibility determinations and facilitate enrollment of children in Medicaid and CHIP by satisfying some or all of the eligibility requirements for these programs. Express Lane agencies include those administering the TANF, Child Support, CHIP, SNAP, School Lunch, WIC, Section 8 and other Federal housing programs, Head Start, Child Care, Homeless Assistance, and Native American Housing Assistance programs.

In addition the State may designate as Express Lane agencies and use the findings of

• Another governmental agency with fiscal liability or legal responsibility for the accuracy of the eligibility determination findings relied on by the State, or

• Governmental agencies that are subject to an interagency agreement limiting the disclosure and use of the information disclosed for purposes of determining eligibility under the State plan.

Express Lane agencies may not include:

• Private, for profit organizations, or

• Agencies that only determine eligibility for programs under the title XX Social Services Block Grant.

If the State elects to use the Express Lane Eligibility authority, it has a number of options for how the Express Lane agency findings are used. It can elect to:

• Use it for applications, redeterminations, or both;

• Automatically enroll children based on the Express Lane agency’s data with the family’s affirmative consent and/or automatically renew or continue eligibility;

• Use State income tax data to determine income eligibility;

• Use “screen and enroll” options to determine income eligibility for Medicaid and CHIP by either establishing a screening threshold amount of income above the Medicaid standard or by temporarily enrolling the child or children in CHIP while determining if the child or children are eligible for Medicaid or CHIP based on a full eligibility determination.

Additional information may be found in SHO # 10-003, dated February 4, 2010.

TECHNICAL GUIDANCE

This template is broken down into the following sections:

Selection of Express Lane Eligibility

Assurance

Provisions

Express Lane Agencies

Eligibility Components

Selection of Express Lane Eligibility

The State indicates whether or not it elects to rely on findings from Express Lane agencies when determining Medicaid eligibility.

Assurance

If the State elects Express Lane eligibility, it must assure that it administers Express Lane Eligibility as described in the template and consistent with section 2107(e)(1)(E) of the Act.

The State provides this affirmative assurance by checking the box next to the assurance statement. If the State does not check this box, the system will not accept this template for review and approval.

Provisions

The first provision: ‘The Express Lane option is used for children under the age of 19’ is pre-checked as it applies to all States.

Next, the State must indicate its selections of certain options:

• The State must indicate if the Express Lane option will be applied to initial determinations (applications) or redeterminations of eligibility, or both.

• The State may elect to enroll children automatically, without an application, based on data from Express Lane agencies and with the family’s or child’s affirmative consent.

• The State may choose to use income eligibility findings from an Express Lane agency that are based on State income tax data.

• The State must select an option for one of the Screen and Enroll requirements in the Act. It must choose one of the following:

  • One screening threshold

  • More than one screening threshold, based on existing age-related income standards for children in the State Plan

  • Temporary enrollment, pending the full eligibility determination

  • The State’s regular screening and enrollment process

If the State selects either ‘One screening threshold’ or ‘More than one screening threshold, based on existing age-related income standards for children in the State Plan’, the State must select whether it uses a threshold which exceeds the highest applicable income standard for children (or for children in specific age-related groups) by:

• 30 percentage points, or

• More than 30 percentage points.

If More than 30 percentage points is selected, the State must specify the number of percentage points and provide a description of how this percentage reflects the differences between the income methodologies of Medicaid the Express Lane agency.

Express Lane Agencies

In addition to selecting the options for its Express Lane eligibility policy, the State must indicate which types of public agencies are approved by the State as Express Lane agencies. See implementation guidance for CS33 Express Lane Agencies.

Eligibility Components

The State must also indicate for each Express Lane Agency which eligibility components are determined by that Express Lane Agency. See implementation guidance for CS34 Express lane Eligibility Components.

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