The Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and the Affordable Care Act (ACA) have provided state Medicaid programs with significant federal dollars to help support eligibility system upgrades and improvements that streamline and simplify the eligibility process for families applying for public health care coverage (Medicaid and CHIP). The federal government has given states limited access to query federal agency data through the Social Security Administration (SSA) and the Department of Labor (DOL) to assist in the data verification components of the application process.
Our objective is to evaluate the impact of using federal data matches to streamline the documentation requirements for citizenship, identity, and income in one southern state.
Methods and Materials
For recent Medicaid recipients in one southern state:
- We used state public insurance eligibility data to retrospectively evaluate the recent procedure change to match and permanently store the results of applicant’s citizenship and identity data with the SSA, using a “pre vs. post” design.
- To prospectively investigate income verification using DOL state quarterly wage files, we manually matched income reported to Medicaid with DOL state wage records.
Results and Findings
Implementation of matching and permanently storing the results of applicant’s citizenship and identity data with SSA resulted in mixed effects. Application processing days decreased, while the number of cases denied due to “failure to verify” slightly increased.
The number of Medicaid applications denied due to “failure to verify” slightly increased after implementation of a SSA data match to verify applicant citizenship and identity.
With respect to prospectively analyzing income matching, we found that only 33 percent of the family Medicaid cases had income in both the state Medicaid database and the DOL database to compare.
Of the one-third of family Medicaid cases that did have income to compare:
•92 percent had a higher income reported in DOL
– 50 percent had zero reported Medicaid income
•8 percent had a higher income reported within Medicaid
Their average quarterly wages in DOL were about $2,000 per quarter. More than half of the remaining cases with income reported by both sources differed by more than 100 percent.
This suggests that the applicant’s citizenship and identity verification are not the primary cause for eligibility to be denied under failure to verify. The more likely reason may be due to the state’s inability to verify income. However, using DOL data to verify income may not be very effective for enrollees in family Medicaid, who have incomes below the ACA Medicaid expansion population.
Implications for Policy and Practice
States that choose not to expand their Medicaid programs in response to the ACA may not see as much benefit from electronic income verification with DOL as states that do expand.
Primary Funding Source
Georgia Department of Community Health and Funding from the CHIPRA Cycle II Grants from the Centers for Medicare & Medicaid Services.
For more information, please visit the Georgia Center of Excellence website.