View Research by Author - Michael Huntress

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With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public coverage. Using 2007 to 2011 quarterly enrollment data, we estimate difference-in-difference equations with quarter and state fixed effects to measure the effect of ELE on enrollment. The estimated impacts of ELE on Medicaid enrollment were consistently positive across model specifications, ranging between 4.0 and 7.3 percent. The analysis also finds that ELE increased Medicaid/CHIP enrollment. Our results imply that ELE has been an effective way for states to increase new enrollment or improve retention among eligible children.

The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) reauthorized CHIP and funded it through 2013. Under CHIPRA, Congress provided states with new policy tools to address shortfalls in enrollment and retention, one of which is Express Lane Eligibility (ELE). With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public health coverage. This evaluation describes existing state ELE programs including the administrative costs and ELE enrollment trends, estimates the impact of ELE adoption on total enrollment, and previews the issues that will be examined through future evaluation activities.

This brief examines variation in Medicaid/CHIP participation among children and parents. Participation continued to vary across states and subgroups of children but differences were found to be narrowing. Medicaid/CHIP participation increased nationally from 81.7 percent in 2008 to 85.8 percent in 2010, which was associated with a decline in uninsurance among eligible children. Participation rates were lower among parents in each state relative to the rates for children. States that had relatively higher/lower participation rates among children were more likely to also have relatively higher/lower participation rates among parents.

Steep declines in the uninsured population under the Affordable Care Act (ACA) will depend on high enrollment among newly Medicaid-eligible adults. We use the 2009 American Community Survey to model pre-ACA eligibility for comprehensive Medicaid coverage among nonelderly adults. We identify 4.5 million eligible but uninsured adults. We find a Medicaid participation rate of 67% for adults; the rate is 17 percentage points lower than the national Medicaid participation rate for children, and it varies substantially across socioeconomic and demographic subgroups and across states. Achieving substantial increases in coverage under the ACA will require sharp increases in Medicaid participation among adults in some states.

This brief provides new national and state-level information about the uninsured adults with incomes below 138 percent of FPL who could become eligible for Medicaid if states decide to expand Medicaid under the Affordable Care Act (ACA). At present, few states cover non-disabled, non-pregnant parents with incomes up to 138 percent of the Federal Poverty Level (FPL) and even fewer cover such adults without dependent children. This analysis shows that the approximately 15 million uninsured adults who could gain coverage under the ACA Medicaid expansion are a diverse group in terms of their age, gender and race/ethnicity.

The Supreme Court ruling on the Affordable Care Act upheld the individual mandate and made the expansion of Medicaid coverage to nonelderly adults with incomes below 138 percent of the federal poverty level optional for states. In this brief, Urban Institute researchers estimate the number of uninsured Americans in each state who could be eligible for Medicaid if every state takes the option of expanding Medicaid coverage. Of 22.3 million uninsured Americans who could be potentially eligible for Medicaid under the ACA, 67 percent (15.1 million) are adults not currently eligible for Medicaid. Of this group, 11.5 million have incomes below poverty and would not qualify for any other subsidized coverage.

The Supreme Court ruling on the Affordable Care Act upheld the individual mandate and made the expansion of Medicaid coverage to nonelderly adults with incomes below 138 percent of the federal poverty level optional for states. The law intended to require all states to undertake the Medicaid expansion. In this brief, Urban Institute researchers estimate the number of uninsured Americans in each state who would be eligible for Medicaid if every state takes the option of expanding Medicaid coverage. The authors also estimate the number of uninsured Americans who are at risk of not being covered because the Medicaid expansion is now optional.

The number of children eligible for and enrolled in Medicaid and CHIP increased in recent years. As a consequence, the number of eligible but uninsured kids fell by about 340,000 between 2008 and 2009. Rates of participation in Medicaid/CHIP increased, from 82.1 to 84.8 percent nationally, with sixteen states achieving participation rates of 90 percent or higher in 2009. This report suggests that the high participation rates among children over the past few years are likely due in part to ongoing federal and state policy efforts aimed at improving enrollment and retention among children.

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