Case Study of Iowa's Express Lane Eligibility Processes

Iowa currently operates two separate Express Lane Eligibility (ELE) processes. First, the state uses a system of referrals between Medicaid and the state’s Children’s Health Insurance Program (CHIP)—called hawk-i—that began five years before the passage of the CHIP Reauthorization Act (CHIPRA) and the formal federal authorization for ELE. Specifically, applications of children who are found ineligible for Medicaid due to excess income are sent to the CHIP program, where they are processed without asking families to reapply or resubmit information. In 2010, Iowa implemented its second ELE process between the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. In contrast to the Medicaid/CHIP referrals, the SNAP/Medicaid ELE process functions as an outreach mechanism rather than an auto-enrollment system. Specifically, families that enroll in SNAP who have children that are not on Medicaid are sent a form offering Medicaid coverage for their children; the form must be completed and returned to the state Department of Human Services (DHS).