Maryland’s experience with Express Lane Eligibility (ELE) predates the passage of the Children’s Health Insurance Program Reauthorization Act (CHIPRA), the legislation that officially provided states with the option to adopt ELE. Prior to CHIPRA’s enactment in 2009, and consistent with the state’s longstanding commitment to providing health coverage to its lowest income citizens, Maryland implemented a process similar to ELE that used information from individual income tax return filings to identify and target outreach efforts to children without health insurance who might be eligible for Medicaid or CHIP (called the Maryland Children’s Health Program, or MCHP). Over time, this process has evolved so that the Department of Health and Mental Hygiene (DHMH)—which administers Maryland’s public coverage programs—can use tax return information on residency, household size, and income to establish Medicaid and MCHP eligibility, provided that taxpayers consent to share their information for this purpose. As a result of this evolution, Maryland received federal approval of its ELE process, helping the state obtain a CHIPRA performance bonus.