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California May Learn From Other States in Move Toward Streamlined Enrollment

California is in the process of streamlining the eligibility and enrollment system for Medi-Cal, the state’s Medicaid program.

In July, Gov. Jerry Brown (D) signed into law two bills — ABX1-1, by Assembly member John Pérez (D-Los Angeles), and SBX1-1, by Sen. Ed Hernandez (D-West Covina) — that included provisions making it easier for California to use income data from existing state assistance programs to determine Medi-Cal eligibility.

As California works to set up its new system, officials could take lessons from other states’ experiences.

Eight states already have implemented such streamlined enrollment systems, called “Express Lane Eligibility,” or ELE. Like the changes envisioned in the new California laws, ELE allows states to use income findings from other agencies to demonstrate eligibility for Medicaid or the Children’s Health Insurance Program.

Lesli Boudreaux, Medicaid program manager for the Louisiana Department of Health and Hospitals, said enacting an ELE system requires a major culture change at state agencies.

“We had to shift to proving people are ineligible rather than proving people are eligible” for Medicaid, Boudreaux said.

Gretel Felton, director of the technical support division for Alabama’s Medicaid program, said ELE has reduced Medicaid application processing times in her state by 19 days on average. She added that the administrative savings from the new system have far outweighed its initial implementation costs.

“You can take the scenic route, or you can take the express lane,” Felton said, adding, “It’s always better to take the express if possible.”

Louisiana and Alabama both received support for their ELE transition from the Maximizing Enrollment project, a joint initiative of the Robert Wood Johnson Foundation and the National Academy for State Health Policy.

Alice Weiss, co-director of Maximizing Enrollment and program director for NASHP, said all states should be moving away from a siloed approach to eligibility and enrollment.

“The family that is walking in your door to get Medicaid or CHIP is the same family that just was down the road trying to apply for SNAP benefits or child care assistance,” she said.

SNAP — the federal Supplemental Nutrition Assistance Program — is known as CalFresh in California. Under California’s planned ELE system, the state will be able to use CalFresh data to determine Medicaid eligibility.

So will the change be challenging for California?

According to Felton, transforming state enrollment systems is never easy. “It’s going to be like surgery: It’s going to hurt a lot at first, but then it’s going to get better,” she said.

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