Express Lane Eligibility: Using
Public Programs to Enroll Eligible
Children into Medicaid/SCHIP
Express Lane Eligibility: Using
Public Programs to Enroll Eligible
Children into Medicaid/SCHIP
Dawn Horner
Georgetown University Health Policy Institute
Center for Children and Families
dch28@georgetown.edu
ccf.georgetown.edu
State Coverage Initiatives Program
May 22, 2007
What is Express Lane
Eligibility?
Express Lane Eligibility is:
A strategy for using other
public programs, like WIC and
School Lunch, to make it easier
for eligible children to enroll
into Medicaid/SCHIP.
Why Express Lane
Eligibility?
Most Uninsured Children Are Now
Eligible for Public Coverage (2004)
SCHIP
Eligible
Medicaid
Eligible
49%
Medicaid
Eligible
66%
19%
21%
32%
13%
SCHIP
Eligible
Not Eligible
Not Eligible
All Uninsured Children
Low-income Uninsured Children
Source: L. Dubay analysis of March 2005 Current Population Survey using July 2004 eligibility rules.
Most Uninsured Children Participate
in other Public Programs
Low-Income, Uninsured Children Whose Families
Participated in Other Public Programs, 2002
80
70
60
50
Percent 40
30
20
10
0
71
59
22
8
NSLP
WIC
Food
Stamps
Any of
these
programs
Source: S. Dorn and G. Kenney, Automatically Enrolling Eligible Children and Families Into Medicaid and SCHIP: Opportunities, Obstacles, and Options for
Federal Policymakers, Economic and Social Research Institute and the Urban Institute, June 2006. Authors’ tabulations based on 2002 National Survey of
America’s Families (NSAF).
Other Public Programs have Similar
Income Eligibility Rules
• School Lunch 
185% FPL
• WIC

185% FPL
• Food Stamps 
130% FPL
Legislative Precedents
• WIC’s Adjunctive Eligibility: accepts an
applicant’s documented participation in Medicaid,
Food Stamps and TANF as evidence of income
eligibility for WIC.
• NSLP’s Categorical Eligibility and Direct
Certification: deems children receiving Food
Stamps, FDPIR and TANF automatically eligible
for free meals and milk.
How Have States Used
Express Lane Eligibility?
Types of Express Lane
•Targeted Outreach
•Streamlined Application
•Automatic Income Eligibility
Targeted Outreach
Target outreach to uninsured children in public
programs with similar eligibility guidelines.
• Most widely used through school lunch.
• Include Medicaid/SCHIP application or outreach
materials with program applications.
• Include question on application or separate form
asking parents if families want to receive health
information.
– Example : Chicago Public Schools
Streamlined Application
Information already collected by a public program is
used to streamline the Medicaid/SCHIP
application process.
• Use public program application as start of
Medicaid/SCHIP application.
• Seek further information, such as immigration
status, to make a final eligibility determination.
– Example: New Jersey, Washington State, California
Deemed Eligibility
Use the fact that a child is enrolled in an incomecomparable program as the basis for determining
the child to be income-eligible for Medicaid or
SCHP.
• Deem children income eligible if public program
more restrictive than Medicaid/SCHIP program.
– Example: New York
A Case Study: California’s
Express Lane Program
About California’s Express Lane
Program
• Linked Medicaid/SCHIP with
free school lunch
• Began July 2003 5 pilot school
districts (70 schools): LA,
Fresno, San Diego, Redwood City
(San Mateo) and Alum Rock (Santa
Clara)
• 10 districts implemented by
2005-06 school year
California’s Express Lane Program:
How it Works
• School lunch application modified to include
information required to make initial Medicaid
eligibility determination and to request consent.
• Schools serves as “qualified entity” and make
presumptive eligibility determination.
• Counties provide presumptive coverage within 5
working days.
• County sends families one page follow-up form
to make final eligibility determination
California’s Express Lane Program:
Results
• School Lunch Program is a fruitful gateway to
health insurance and enrolling children in Medi-Cal
– If ELE were applied statewide, it could reach up
to 500,000 uninsured children in CA
• Children received presumptive eligibility: 68% of
those who applied and were not already enrolled
• Fewer children than hoped enrolled in ongoing
coverage: 40% of children that presumptive
coverage received ongoing coverage
Continuing the Progress
Lessons Learned/Moving Forward
• States Can Do a Lot Now to Implement Streamlined
Mechanisms
• Federal Assistance Needed to Move Toward Automatic
• Computer System/Technology Simplifications Critical to
Success
• Need for Outreach/Follow-Up to Families Never Goes
Away
For More Information
www.expresslaneinfo.org