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Health Care Utilization among Children Enrolled in Medicaid and CHIP via Express Lane Eligibility
Margaret Colby1, Brenda Natzke1
1Mathematica Policy Research, Washington, DC.
Insights
Children enrolled in Medicaid and CHIP using Express Lane Eligibility (ELE) accessed health services. However, ELE enrollees showed slightly lower utilization and intensity of care compared to standard enrollees.
Area of Science:
- Health Services Research
- Public Health Policy
- Pediatric Healthcare Access
Background:
- Medicaid and Children's Health Insurance Program (CHIP) provide essential health coverage to low-income children.
- Express Lane Eligibility (ELE) streamlines enrollment for eligible children, potentially increasing coverage rates.
Purpose of the Study:
- To evaluate healthcare utilization patterns among children enrolled in Medicaid and CHIP through the ELE pathway.
- To compare the healthcare use of ELE enrollees with children who enrolled via traditional methods.
Main Methods:
- Analysis of enrollment, claims, and encounter data from four states (Alabama, Iowa, Louisiana, New Jersey) between 2009-2012.
- Comparative analysis of healthcare utilization (likelihood, volume, cost) between ELE and standard enrollees.
- Regression adjustment to account for demographic variations between groups.
Main Results:
- The majority of children in both ELE and comparison groups utilized healthcare services within one year of enrollment.
- Commonly accessed services included outpatient care, prescription drugs, and dental/vision services.
- ELE enrollees demonstrated slightly lower likelihoods of using specific services and less intensive service use compared to standard enrollees.
Conclusions:
- ELE enrollees demonstrate awareness of their public health insurance coverage by accessing and utilizing services.
- Findings suggest that newly eligible but uninsured children may represent a lower-cost population to cover compared to existing beneficiaries.
Objective:
To assess health care utilization among children enrolled in Medicaid and CHIP via Express Lane Eligibility (ELE).
Data Sources/Study Setting:
Enrollment, claims, and encounter data for children enrolled in Medicaid or CHIP in Alabama, Iowa, Louisiana, and New Jersey during 2009-2012.
Study Design:
We compared health care utilization among children enrolled via ELE and nondisabled children who enrolled through standard pathways in each state. We used a two-step estimation approach, examining the likelihood of utilization and then the volume and cost of services among users. Regression adjustment corrected for demographic differences.
Principal Findings:
Most ELE and comparison group children used services within a year of enrollment and accessed a variety of services, including outpatient care, prescription drugs, and dental and vision care. ELE enrollees were somewhat less likely to use each service type, and those who used services often did so less intensively compared to other enrollees in their state.
Conclusions:
Health care use patterns suggest that ELE enrollees are aware of their coverage; enrollees accessed and repeatedly used services covered by public health insurance. However, states considering this policy may expect that remaining eligible but uninsured children may be less expensive to cover than existing beneficiaries.
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