About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

GAO-13-178R 1 (2012-12-05)

handle is hein.gao/gaobacgsf0001 and id is 1 raw text is: GAO Accountablty *Integrity * Reliability United States Government Accountability Office Washington, DC 20548 December 5, 2012 The Honorable Max Baucus Chairman Committee on Finance United States Senate Subject: Medicaid and CHIP: Considerations for Express Lane Eligibility Dear Mr. Chairman: Each year, millions of children do not have health insurance coverage even though they are eligible for Medicaid or the Children's Health Insurance Program (CHIP), two joint federal-state programs that provide health insurance to certain low-income individuals.1 Additionally, each year, some children lose Medicaid or CHIP coverage for which they are eligible and then, after a short coverage gap, reenroll-a process that is costly to the programs administratively, as well as burdensome for families.2 The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) provided states with new incentives and tools to simplify eligibility determinations and increase the enrollment and retention of children in Medicaid and CHIP. One of these tools is Express Lane Eligibility (ELE), which allows states to determine eligibility for children in Medicaid or CHIP by using certain information, such as information from other public-assistance programs that enroll children.3 Specifically, within certain limits, ELE allows a state Medicaid or CHIP agency to use another 1Medicaid finances health insurance for certain categories of individuals, including low-income children; CHIP is an insurance program for certain low-income, uninsured children whose family income is too high for Medicaid. Under Medicaid and CHIP, states pay qualified health care providers for covered services given to enrolled beneficiaries, and then seek reimbursement for the federal share of those payments. In fiscal year 2010, 34.4 million children had health coverage through Medicaid, and 7.7 million children had health care coverage through CHIP, while approximately 8 million children were uninsured. The specific factors considered in determining eligibility for Medicaid and CHIP vary across states and generally involve income, disability status, residency, age, and citizenship. 2For example, many children who are still eligible lose coverage because the family failed to respond accurately or on time to notices to renew eligibility (children's enrollment must be renewed at least once a year). Some children disenroll from CHIP or Medicaid because they are no longer eligible or obtain private coverage. 3pub. L. No. 111-3, § 203(a), 123 Stat. 8, 40 (2009) (codified, as amended, at 42 U.S.C. § 1396a(e)(1 3)). Under CHIPRA, the ELE option may only be used for Medicaid and CHIP eligibility determinations for children and cannot be used for parents or other adults. CHIPRA established new performance bonuses for states adopting at least five of eight specified policies to simplify Medicaid and CHIP enrollment and retention procedures for children; one of the specified policies was ELE. States are eligible for these performance bonuses for fiscal years 2009 through 2013. See Pub. L. No. 111-3, § 104, 123 Stat. 8, 17-23. GAO-1 3-178R Express Lane Eligibility Page I

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most