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Journal Issue: Health Insurance for Children Volume 13 Number 1 Spring 2003

Express Lane Eligibility
Dawn Horner Wendy Lazarus Beth Morrow


Although great progress has been made in providing health coverage to low-income children, 9.2 million children remain uninsured. About 6.8 million of these children are eligible for public health insurance coverage.1 (See the article by Holahan, Dubay, and Kenney in this journal issue.) Many of these uninsured children are enrolled in other public programs for low-income families that have eligibility requirements similar to those for public health insurance programs (Medicaid and the State Children's Health Insurance Program, or SCHIP).2 Most low-income, uninsured children (63%, or 4.3 million) are concentrated in families that receive benefits through food stamps, the National School Lunch Program, or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).3 The school lunch program alone reaches 3.7 million uninsured children, representing more than one-half of all low-income, uninsured children in the United States.4 Therefore, targeting outreach to and simplifying health insurance enrollment for uninsured children enrolled in other public programs is both logical and efficient.

Programs like food stamps, WIC, and school lunch provide an obvious opportunity to link low-income children with health coverage. States could use eligibility information that families have provided to these programs as a basis for enrolling children in public health insurance coverage, but most states have no such system in place. Instead, families usually must visit multiple public agencies and submit duplicative information to each.

This article describes some states' creative strategies to increase children's enrollment in health insurance by connecting Medicaid and SCHIP with other public programs for low-income children and families. These strategies, referred to as "express lane eligibility" (ELE),5 have the potential to significantly increase the number of low-income children with health insurance. The article begins with an overview of how ELE works, then assesses challenges facing ELE, and closes by offering several recommendations for how states can expand their use of ELE strategies.