GIS 17 MA/014: Changes to Express Lane Eligibility Process

The purpose of this General Information System (GIS) message is to inform local departments of social services of upcoming changes to the Express Lane Eligibility (ELE) process for Child Health Plus (CHPlus) and the Medicaid program. Beginning June 1, 2017, for renewals with an end date of July 31, 2017, children who were enrolled in CHPlus by a participating health plan will begin to transition to NY State of Health. This process will continue for 12 months until all children enrolled through a CHPlus health plan have been transitioned to NY State of Health.

Previously, when a child renewed for CHPlus through a participating health plan, and was determined to have income at or below the applicable Medicaid level, the child was given two months of temporary CHPlus coverage and the case information was sent to the district to open a Medicaid case. Using the ELE option, the Medicaid eligibility was based on the findings of the CHPlus program.

This process of transitioning children from CHPlus to Medicaid under ELE will end as children are transitioned to NY State of Health for renewal. Starting June 1, 2017, health plans will no longer send paper CHPlus renewal applications for completion. Instead, plans will send a notice informing individuals that they must apply for continued coverage on NY State of Health. Marketplace facilitators will assist families in completing this process to ensure a smooth transition without a gap in coverage.

As a reminder, the ELE process used to transition children from Medicaid to CHPlus ended as of February 2015. At that time, CNS was updated with language to refer children no longer eligible for Medicaid due to excess income to NY State of Health to apply for available insurance coverage.

Please direct any questions to your Local District Support Liaison.