Health Care Utilization Among Children Enrolled in Medicaid and CHIP via Express Lane Eligibility

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.