Louisiana Breaks New Ground

The Nation's First Use of Automatic Enrollment Through Express Lane Eligibility

This study finds that automatic enrollment in health coverage programs yielded significant administrative savings for the state of Louisiana, as well as improved access to care for eligible residents. The report reviews Louisiana’s pioneering use of Express Lane Eligibility (ELE)—a mechanism enabling the state to identify and enroll eligible children in Medicaid and the Children’s Health Insurance Program (CHIP) using pre-existing data from sources like state income tax records and the Supplemental Nutrition Assistance Program (SNAP), formally known as the food stamp program.

Prepared by Urban Institute researchers, and funded by the Robert Wood Johnson Foundation's (RWJF) State Health Access Reform Evaluation (SHARE), the report states that while implementing ELE took considerable work, the results more than justified the effort.

Key Findings:

  • The number of uninsured children in the state fell from more than 58,000 to just over 42,000.
  • The proportion of uninsured, Medicaid-eligible children declined from 5.3 percent to 2.9 percent.
  • For each dollar spent developing necessary infrastructure, $15–$22 in administrative cost savings resulted.

The authors conclude that the state’s first-in-the-country use of ELE deserves serious consideration as others face the challenges associated with enrolling newly eligible residents into Medicaid/CHIP, as well as the state insurance exchanges.

SHARE, a national program of RWJF, aims to provide evidence to state policy-makers on specific mechanisms that contribute to successful state health reform efforts.