Health Insurance (HX) Section


----------------------------------------------------
THROUGHOUT THE SPECIFICATIONS FOR THIS CAPI
SECTION, FOR SCREENS THAT SPECIFY THE REFERENCE
PERIOD {END DATE} AS PART OF THE CONTEXT HEADER,
CAPI DISPLAYS THE {END DATE} ONLY FOR ROUND 5. IN
ANY OTHER ROUND, CAPI DOES NOT DISPLAY THE {END
DATE} IN THE CONTEXT HEADER. FOR MOST PERSONS, THE
END DATE FOR ROUND 5 WILL BE DECEMBER 31 OF THE
SECOND YEAR OF THE PANEL.
----------------------------------------------------


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
FOR MONTH DISPLAY 3 CHAR MONTH (EG. JAN, FEB)

ROUNDS 1-4, DISPLAY ONLY THE BEGIN DATE RATHER
THAN BOTH THE BEGIN AND END DATE. IF ROUND 5 THEN
DISPLAY BOTH THE BEGIN AND END DATE.

DISPLAY PERS.FULLNAME, ESTB.ESTBNAME,
PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY,
PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY
----------------------------------------------------


HX01
====

{STR-DT}
{END-DT}

Let’s talk (again) about all the health insurance coverage the
family may have to help pay for the costs of medical care {since
(START DATE)/between (START DATE) and (END DATE)}.

{ASK RESPONDENT TO GET INSURANCE CARDS/IDENTIFYING INFORMATION
IF NOT ALREADY AVAILABLE.}

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------
DISPLAY ‘ASK....AVAILABLE.’ IF ROUND 1.
OTHERWISE, USE A NULL DISPLAY.

DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.
DISPLAY ‘between (START DATE) and (END DATE)’ IF
ROUND 5.
----------------------------------------------------

----------------------------------------------------
IF ROUND 1, GO TO BOX_03
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_01
----------------------------------------------------


BOX_01
======

----------------------------------------------------
ASK THE OLD EMPLOYMENT AND PRIVATE RELATED
INSURANCE (OE) SECTION.
----------------------------------------------------

----------------------------------------------------
AT COMPLETION OF OE SECTION, CONTINUE WITH BOX_02
----------------------------------------------------


BOX_02
======

----------------------------------------------------
ASK THE OLD PUBLIC RELATED INSURANCE (PR) SECTION.
----------------------------------------------------

----------------------------------------------------
AT COMPLETION OF PR SECTION, CONTINUE WITH BOX_03
----------------------------------------------------


BOX_03
======

----------------------------------------------------
IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS MEET THE
FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS
PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS ‘NOT SELF-EMPLOYED’
OR IS FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-
SIZE-GREATER-THAN-1,
CONTINUE WITH LOOP_01
----------------------------------------------------

----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------


LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-PAIRS-
ROSTER, ASK NAV_HX01A - END_LP01
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION
ABOUT PRIVATE HEALTH INSURANCE OBTAINED THROUGH
AN EMPLOYER. THIS LOOP CYCLES ON ESTABLISHMENT-
PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS
PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS ‘NOT SELF-EMPLOYED’
OR IS FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-
SIZE-GREATER-THAN-1.
----------------------------------------------------

----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES BOTH NAV_HX01A
AND NAV_HX01B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------


NAV_HX01A
=========

{STR-DT}

SERIES: Health Insurance Through Establishments

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

RU Member

[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS-
ROSTER FOR SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS
STATED AT THE LOOP_01 DEFINITION.
----------------------------------------------------

----------------------------------------------------
CONTINUE WITH NAV_OE01B FOR SELECTED RU MEMBER
----------------------------------------------------


NAV_HX01B
=========

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}

SERIES: Verifying Insurance during the Reference Period
(including selecting a Policyholder)

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

RU Member...Employer Providing Insurance

[1. Person’s Name-65]...[Establishment Name-30] [Status-25]
[2. Person’s Name-65]...[Establishment Name-30] [Status-25]
[3. Person’s Name-65]...[Establishment Name-30] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER...EMPLOYER PROVIDING
INSURANCE
INSTRUCTIONS: DISPLAY RU-ESTABLISHMENT-PERSON-
PAIR
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH PAIR EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL EMPLOYERS THAT MEET THE CONDITIONS
STATED AT THE LOOP_01 DEFINITION.
----------------------------------------------------

----------------------------------------------------
CONTINUE WITH HX02 FOR SELECTED PAIR
----------------------------------------------------


HX02
====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

You mentioned that (PERSON) (were/was) covered by health
insurance from (ESTABLISHMENT) {at some point after (START
DATE)/between (START DATE) and (END DATE)}.

SELECT ‘CONTINUE’ UNLESS RESPONDENT VOLUNTEERS INSURANCE
REPORTED IN ERROR.

CONTINUE ............................... 1 {BOX_04}
INSURANCE REPORTED IN ERROR ............ 2 {END_LP01}

[Code One]

----------------------------------------------------
IF ROUND 1 THROUGH ROUND 4, DISPLAY ‘at some point
after (START DATE)’. IF ROUND 5, DISPLAY ‘between
(START DATE) and (END DATE)’.
----------------------------------------------------

----------------------------------------------------
‘(ESTABLISHMENT)’ AND ‘(START DATE)’ IN RESPONSE
LABELS SHOULD BE PURPLE.
----------------------------------------------------

----------------------------------------------------
IF CODED ‘2’ (INSURANCE REPORTED IN ERROR) FLAG
THIS ESTABLISHMENT-PERSON-PAIR AS ‘NOT SEPARATE
SOURCE OF INSURANCE’ AND GO TO END_LP01
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_04
----------------------------------------------------


BOX_04
======

----------------------------------------------------
ASK THE PRIVATE HEALTH INSURANCE DETAIL (HP)
SECTION FOR THIS ESTABLISHMENT-PERSON-PAIR.
----------------------------------------------------

----------------------------------------------------
AT COMPLETION OF HP SECTION, CONTINUE WITH
END_LP01
----------------------------------------------------


END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN
THE LOOP DEFINITION.
----------------------------------------------------

----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS,
END LOOP_01 AND CONTINUE WITH BOX_05
----------------------------------------------------


BOX_05
======

----------------------------------------------------
IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS MEET
THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS
PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’
AND
- FIRM SIZE OF ESTABLISHMENT = 1,
CONTINUE WITH LOOP_02
----------------------------------------------------

----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------


LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-PAIRS-
ROSTER, ASK LOOP_03-END_LP02
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION
ABOUT THE SOURCES OF DIRECTLY PURCHASED HEALTH
INSURANCE ASSOCIATED WITH A SELF-EMPLOYED JOB
WHERE FIRM SIZE = 1. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET THE
FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS
PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’
- FIRM SIZE OF ESTABLISHMENT = 1
----------------------------------------------------


LOOP_03
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

INSURANCE CATEGORY 1
INSURANCE CATEGORY 2
INSURANCE CATEGORY 3
INSURANCE CATEGORY 4
INSURANCE CATEGORY 5
INSURANCE CATEGORY 6

ASK HX03 - END_LP03
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS INFORMATION
ABOUT THE WAYS PERSON PURCHASED HEALTH INSURANCE
(INSURANCE CATEGORIES AT HX03) ASSOCIATED WITH A
SELF-EMPLOYED JOB WITH FIRM-SIZE = 1. THE FIRST
CYCLE OF THIS LOOP COLLECTS THE MAIN WAY PERSON
PURCHASES INSURANCE. SUBSEQUENT CYCLES COLLECT
ADDITIONAL WAYS PERSON PURCHASES INSURANCE.

THE RESPONSE AT HX04 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF HX04 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT INSURANCE
CATEGORY. IF HX04 IS CODED ‘2’ (NO), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), THE LOOP ENDS.
----------------------------------------------------


HX03
====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

SHOW CARD HX-1.

{You mentioned that (PERSON) {(are/is)/(were/was)} self-employed
and had health insurance through that business.} Which
category on this card comes closest to {the main/another} way
(PERSON) (purchase/purchases) this insurance?

FROM A PROFESSIONAL ASSOCIATION ........ 1 {BOX_06}
FROM A SMALL BUSINESS GROUP ............ 2 {BOX_06}
FROM A UNION ........................... 3 {BOX_06}
DIRECTLY FROM AN INSURANCE AGENT ....... 5 {BOX_06}
DIRECTLY FROM INSURANCE COMPANY ........ 6 {BOX_06}
DIRECTLY FROM AN HMO ................... 7 {BOX_06}
FROM A PREVIOUS EMPLOYER ............... 8 {BOX_06}
FROM A PREVIOUS EMPLOYER (COBRA) ....... 9 {BOX_06}
DIRECTLY FROM A HIGH RISK POOL {/{STATE
NAME FOR HIGH RISK POOL}} ........... 10 {BOX_06}
OTHER ................................. 91 {HX03OV}

[Code One]

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

----------------------------------------------------
STARTING IN PANEL 12 ROUND 2, CATEGORY ‘4’ (FROM
A HEALTH INSURANCE PURCHASING ALLIANCE) WAS
OMITTED AND WILL BE OMITTED IN ALL FUTURE ROUNDS.
----------------------------------------------------

----------------------------------------------------
STARTING IN PANEL 14 ROUND 5, PANEL 15 ROUND 3 AND
PANEL 16 ROUND 1, CATEGORY ‘10’ (DIRECTLY FROM A
HIGH RISK POOL{/{STATE NAME FOR HIGH RISK POOL}})
WAS ADDED AND WILL BE ADDED IN ALL FUTURE ROUNDS.
----------------------------------------------------

----------------------------------------------------
DISPLAY ‘you mentioned that (PERSON) {(are/is)/
(were/was)} self-employed and had health insurance
through that business.’ IF FIRST CYCLE THROUGH
LOOP_03. OTHERWISE USE A NULL DISPLAY.

DISPLAY ‘(are/is)’ IF ESTABLISHMENT IS FLAGGED AS
A CURRENT EMPLOYER. DISPLAY ‘(were/was)’ IF
ESTABLISHMENT IS NOT FLAGGED AS A CURRENT
EMPLOYER, OR IF CURRENT ROUND IS ROUND 5.

DISPLAY ‘the main’ IF FIRST CYCLE THROUGH LOOP_03.
OTHERWISE (I.E., NOT FIRST CYCLE), DISPLAY
‘another’.

DISPLAY ‘/{STATE NAME FOR HIGH RISK POOL}’ IF
STATE IN WHICH INTERVIEW IS BEING CONDUCTED OFFERS
A HIGH RISK POOL HEALTH INSURANCE PLAN. THIS
INCLUDES ALL STATES EXCEPT: AZ, DE, DC, GA, HI,
ME, MA, MI, NV, NJ, NY, OH, PA, RI, VT, VA. IF
INTERVIEW STATE IS ONE OF THESE STATES, USE A NULL
DISPLAY.

FOR ‘STATE NAME FOR HIGH RISK POOL’ DISPLAY THE
HIGH RISK POOL PLAN NAME ASSOCIATED WITH THE STATE
IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------


HX03OV
======

OTHER:

[Enter Other Specify] .................. {BOX_06}
DK .................................... -8 {BOX_06}


BOX_06
======

----------------------------------------------------
ASK PRIVATE HEALTH INSURANCE DETAIL (HP) SECTION
FOR THE RESPONSE CATEGORY SELECTED AT HX03.
----------------------------------------------------

----------------------------------------------------
AT COMPLETION OF HP SECTION, CONTINUE WITH HX04
----------------------------------------------------


HX04
====

{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF
ESTABLISHMENT} {STR-DT}
{END-DT}

SHOW CARD HX-1.

Aside from what you already told me about, is there another
category on this card which describes the way (PERSON)
(purchase/purchases) health insurance for (ESTABLISHMENT)?

YES .................................... 1 {END_LP03}
NO ..................................... 2 {END_LP03}
REF ................................... -7 {END_LP03}
DK .................................... -8 {END_LP03}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.


END_LP03
========

----------------------------------------------------
IF HX04 IS CODED ‘1’ (YES), CYCLE TO COLLECT THE
NEXT WAY OF PURCHASING INSURANCE.
----------------------------------------------------

----------------------------------------------------
OTHERWISE, END LOOP_03 AND CONTINUE WITH END_LP02
----------------------------------------------------


END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN
THE LOOP DEFINITION.
----------------------------------------------------

----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS,
END LOOP_02 AND CONTINUE WITH BOX_07
----------------------------------------------------


BOX_07
======

----------------------------------------------------
IF ROUND 1, GO TO HX06
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_08
----------------------------------------------------


BOX_08
======

----------------------------------------------------
IF:

ANY NEW RU MEMBERS ADDED TO RU THIS ROUND,
OR
ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING
MEDICARE TURNED 65 SINCE START DATE (USE REAL
DATE OF BIRTH ONLY),
OR
ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING
MEDICARE WERE = OR > 65 (OR IN AGE CATEGORY 9) IN
PREVIOUS ROUND,
CONTINUE WITH HX05
----------------------------------------------------

----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------


HX05
====

{STR-DT}
{END-DT}

We show that (READ NAMES BELOW) {(are/is)} {either} {65 years old
or older} {or} {joined the household since our last interview}.

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]

(Has (READ NAME ABOVE)/Have any of these people) been covered
by Medicare {since (START DATE)/between (START DATE) and (END DATE)}?

YES .................................... 1
NO ..................................... 2 {LOOP_04}
REF ................................... -7 {LOOP_04}
DK .................................... -8 {LOOP_04}

HELP AVAILABLE FOR DEFINITION OF MEDICARE.

----------------------------------------------------
DISPLAY ‘(are/is)’ AND ‘65 years old’ IF ANY RU
MEMBERS NOT ALREADY FLAGGED AS RECEIVING
MEDICARE TURNED 65 SINCE START DATE OR IF ANY RU
MEMBERS NOT ALREADY FLAGGED AS RECEIVING
MEDICARE WERE = OR > 65 PREVIOUS ROUND.

DISPLAY ‘joined the household since our last
interview’ IF ANY NEW RU MEMBERS ADDED TO THE RU
THIS ROUND.

DISPLAY ‘either’ AND ‘or’ IF ANY NEW RU MEMBERS
ADDED TO THE RU THIS ROUND AND IF ANY RU MEMBERS
NOT ALREADY FLAGGED AS RECEIVING MEDICARE TURNED
65 SINCE START DATE OR ANY RU MEMBERS NOT ALREADY
FLAGGED AS RECEIVING MEDICARE WERE = OR > 65
PREVIOUS ROUND.

DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.
DISPLAY ‘between (START DATE) and (END DATE)’ IF
ROUND 5.
----------------------------------------------------

----------------------------------------------------
IF HX05 IS CODED ‘1’ (YES) AND ONLY ONE RU MEMBER
ELIGIBLE FOR HX05, SELECT THAT PERSON
AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------

----------------------------------------------------
IF HX05 IS CODED ‘1’ (YES) AND MORE THAN ONE RU
MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------

----------------------------------------------------
ROSTER DETAILS:
Title: RU_MEMBERS_1

COL #1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY
OF RU-MEMBERS.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
OTHERWISE, DISPLAY RU-MEMBERS WHO MEET ONE OF THE
FOLLOWING CONDITIONS:
1. PERSON IS A NEW RU MEMBER THIS ROUND,

2. PERSON TURNED 65 YEARS OLD THIS ROUND AND IS
NOT FLAGGED AS COVERED BY MEDICARE DURING ANY
ROUND,

3. OR PERSON >= 65 (OR IN AGE CATEGORY 9) LAST
ROUND AND NOT FLAGGED AS COVERED BY MEDICARE
DURING ANY ROUND.
----------------------------------------------------


HX06
====

{STR-DT}

SHOW CARD HX-2.

Medicare is a health insurance program for persons 65 years or
over and for some disabled persons. People covered by Medicare
usually have a card that looks like this.

At any time since (START DATE), has anyone in the family been
covered by Medicare?

YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

HELP AVAILABLE FOR DEFINITION OF MEDICARE.

----------------------------------------------------
IF CODED ‘1’ (YES) AND SINGLE-PERSON RU, SELECT
PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO
LOOP_04
----------------------------------------------------

----------------------------------------------------
IF CODED ‘1’ (YES) AND MULTI-PERSON RU, CONTINUE
WITH HX07
----------------------------------------------------

----------------------------------------------------
IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW) AND ONE OR MORE RU MEMBER = > 65 YEARS OLD,
GO TO LOOP_04
----------------------------------------------------

----------------------------------------------------
IF CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW) AND NO RU MEMBER = > 65 YEARS OLD, GO
TO BOX_12
----------------------------------------------------


HX07
====

{STR-DT}
{END-DT}

Who is covered by Medicare?

PROBE: Who else is covered by Medicare?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65] {LOOP_04}

----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_SELECTONE

COL # 1 HEADER: PERSON-TYPE-PROVIDER
INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR
SELECTION OF RU MEMBERS.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT
ONE OR MORE FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
IN ROUND 1, NONE. DISPLAY ALL.
IN ROUNDS 2-5, DISPLAY RU MEMBERS WHO MEET ONE OF
THE FOLLOWING CONDITIONS:
1. PERSON IS A NEW RU MEMBER THIS ROUND,

2. PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT
FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND,

3. OR PERSON >= 65 YEARS OLD (OR IN AGE CATEGORY
9) LAST ROUND AND NOT FLAGGED AS COVERED BY
MEDICARE DURING ANY ROUND.
----------------------------------------------------


LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK
BOX_09 - END_LP04
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_04 DETERMINES IF REASON FOR
MEDICARE IS CONDITION/DISABILITY FOR PERSONS < 65
WHO RECEIVE MEDICARE AND COLLECTS SOCIAL SECURITY
STATUS FOR PERSONS = > 65 WHO ARE NOT COVERED BY
MEDICARE. THIS LOOP CYCLES ON PERSONS WHO MEET
ANY OF THE FOLLOWING CONDITIONS:
- IF ROUND 1: ALL CURRENT RU MEMBERS
- IF NOT ROUND 1: ALL CURRENT RU MEMBERS WHO
MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND,
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT
FLAGGED AS COVERED BY MEDICARE DURING ANY
ROUND
OR
- PERSON => 65 YEARS OLD (OR IN AGE CATEGORY 9)
LAST ROUND AND NOT FLAGGED AS COVERED BY
MEDICARE DURING ANY ROUND.
----------------------------------------------------

----------------------------------------------------
NAVIGATOR DETAILS: LOOP_04 USES EITHER NAV_HX04A
OR NAV_HX04B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------


BOX_09
======

----------------------------------------------------
IF ROUND 1, GO TO BOX_11
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_10
----------------------------------------------------


BOX_10
======

----------------------------------------------------
IF PERSON ADDED THIS ROUND, CONTINUE WITH BOX_11
----------------------------------------------------

----------------------------------------------------
IF HX05 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW) AND RU MEMBER TURNED 65 THIS
ROUND, GO TO NAV_HX04B
----------------------------------------------------

----------------------------------------------------
OTHERWISE, GO TO END_LP04
----------------------------------------------------

----------------------------------------------------
NOTE: HX09 IS NOT RE-ASKED OF PERSONS WHO WERE
OVER 65 DURING THE PREVIOUS ROUND AND DID NOT
RECEIVE MEDICARE AND WHO CONTINUE NOT RECEIVING
MEDICARE DURING THE CURRENT ROUND.
----------------------------------------------------


BOX_11
======

----------------------------------------------------
IF PERSON IS SELECTED AT HX07 AND IS < 65 YEARS
OLD (OR IN AGE CATEGORIES 1-8), CONTINUE WITH
NAV_HX04A
----------------------------------------------------

----------------------------------------------------
IF PERSON IS SELECTED AT HX07 AND IS = > 65 YEARS
OLD (OR IN AGE CATEGORY 9), GO TO END_LP04
----------------------------------------------------

----------------------------------------------------
IF PERSON IS NOT SELECTED AT HX07 AND IS < 65
YEARS OLD (OR IN AGE CATEGORIES 1-8), GO TO
END_LP04
----------------------------------------------------

----------------------------------------------------
IF PERSON IS NOT SELECTED AT HX07 AND IS = > 65
YEARS OLD (OR IN AGE CATEGORY 9), GO TO NAV_HX04B
----------------------------------------------------

----------------------------------------------------
IF HX07 IS NOT ASKED (I.E., HX05 OR HX06 IS CODED
‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW))
AND PERSON IS < 65 YEARS OLD (OR IN AGE CATEGORIES
1-8), GO TO END_LP04
----------------------------------------------------

----------------------------------------------------
IF HX07 IS NOT ASKED (I.E., HX05 OR HX06 IS CODED
‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW))
AND PERSON IS = > 65 YEARS OLD (OR IN AGE CATEGORY
9), GO TO NAV_HX04B
----------------------------------------------------


NAV_HX04A
=========

{STR-DT}

SERIES: Medicare for RU Members Under 65

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

RU Member

[1. Reason for Medicare [Person’s Name-65]] [Status-25]
[2. Reason for Medicare [Person’s Name-65]] [Status-25]
[3. Reason for Medicare [Person’s Name-65]] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX07 AND WHO
ARE < 65 YEARS OLD (OR IN AGE CATEGORIES 1-8).
----------------------------------------------------

----------------------------------------------------
GO TO HX08 FOR SELECTED RU MEMBER.
----------------------------------------------------


NAV_HX04B
=========

SERIES: Receive Social Security for Someone 65+ Without Medicare

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

Question Series

[1. Receive Social Security...[Person’s Name-65]] [Status-25]
[2. Receive Social Security...[Person’s Name-65]] [Status-25]
[3. Receive Social Security...[Person’s Name-65]] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: QUESTION SERIES
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED WHO MEET THE
FOLLOWING CONDITIONS (SEE BOX_10 AND BOX_11):

- HX05 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW) AND RU MEMBER TURNED 65 THIS
ROUND
OR
- PERSON IS NOT SELECTED AT HX07 AND IS = > 65
YEARS OLD (OR IN AGE CATEGORY 9)
OR
- HX07 IS NOT ASKED (I.E., HX05 OR HX06 IS CODED
‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW))
AND PERSON IS = > 65 YEARS OLD (OR IN AGE
CATEGORY 9)
----------------------------------------------------

----------------------------------------------------
GO TO HX09 FOR SELECTED RU MEMBER.
----------------------------------------------------


HX08
====

{PERSON’S FIRST MIDDLE AND LAST NAME}

(Do/Does) (PERSON) receive Medicare because of a medical
condition or a disability?

YES .................................... 1 {END_LP04}
NO ..................................... 2 {END_LP04}
REF ................................... -7 {END_LP04}
DK .................................... -8 {END_LP04}

HELP AVAILABLE FOR DEFINITION OF CONDITION/DISABILITY.


HX09
====

{PERSON’S FIRST MIDDLE AND LAST NAME}

People with Social Security usually get Medicare. (Do/Does)
(PERSON) receive Social Security?

YES .................................... 1 {END_LP04}
NO ..................................... 2 {END_LP04}
REF ................................... -7 {END_LP04}
DK .................................... -8 {END_LP04}

HELP AVAILABLE FOR DEFINITION OF SOCIAL SECURITY.


END_LP04
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER WHO
MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------

----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS,
END LOOP_04 AND CONTINUE WITH BOX_12
----------------------------------------------------


BOX_12
======

----------------------------------------------------
IF MEDICAID/SCHIP PROVIDED TO ANY RU MEMBER
DURING THE PREVIOUS ROUND, GO TO BOX_14
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_12A
----------------------------------------------------


BOX_12A
=======

----------------------------------------------------
IF GOVT-HOSPITAL/PHYSICIAN IS A SOURCE OF
INSURANCE FOR ANY RU MEMBER DURING THE CURRENT
ROUND, GO TO BOX_14
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH HX10
----------------------------------------------------


HX10
====

{STR-DT}
{END-DT}

SHOW CARD HX-3.

{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} are state
programs that pay for health care for persons in need. People covered
by {Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME} may have
a (piece of paper/card) that looks something like this.

At any time {since (START DATE)/between (START DATE) and (END DATE)},
has anyone in the family been covered by {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME}?

YES .................................... 1
NO ..................................... 2 {BOX_14}
REF ................................... -7 {BOX_14}
DK .................................... -8 {BOX_14}

HELP AVAILABLE FOR DEFINITION OF MEDICAID/SCHIP.

----------------------------------------------------
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY
‘STATE NAME FOR MEDICAID’ (SUBSTITUTING THE REAL
STATE NAME FOR PROGRAM) IF THE STATE IN WHICH
INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME
‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY
STATE, SEE ATTACHMENT 37.
----------------------------------------------------

----------------------------------------------------
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS
SUBSTITUTING THE REAL NAME FOR PROGRAM. FOR THE
SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 37.
----------------------------------------------------

----------------------------------------------------
DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.
DISPLAY ‘between (START DATE) and (END DATE)’ IF
ROUND 5.
----------------------------------------------------

----------------------------------------------------
IF CODED ‘1’ (YES) AND SINGLE-PERSON RU, SELECT
PERSON AUTOMATICALLY BY CAPI AT HX11 AND GO TO
LOOP_05
----------------------------------------------------

----------------------------------------------------
IF CODED ‘1’ (YES) AND MULTI-PERSON RU, CONTINUE
WITH HX11
----------------------------------------------------


HX11
====

{STR-DT}
{END-DT}

Who is covered by {Medicaid/{STATE NAME FOR MEDICAID}} or
{STATE CHIP NAME}?

PROBE: Who else is covered by {Medicaid/{STATE NAME FOR
MEDICAID}} or {STATE CHIP NAME}?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]

----------------------------------------------------
DISPLAY ‘Medicaid’ IF STATE IN WHICH INTERVIEW IS
BEING CONDUCTED USES THE NAME ‘MEDICAID’. DISPLAY
‘STATE NAME FOR MEDICAID’ (SUBSTITUTING THE REAL
STATE NAME FOR PROGRAM) IF THE STATE IN WHICH
INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME
‘MEDICAID.’ FOR THE SPECIFIC NAME TO USE BY
STATE, SEE BOX ON HX06.
----------------------------------------------------

----------------------------------------------------
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS
SUBSTITUTING THE REAL NAME FOR PROGRAM. FOR THE
SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 37.
----------------------------------------------------

----------------------------------------------------
GO TO LOOP_05
----------------------------------------------------

----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION OF RU MEMBERS.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT
FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOLWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------


LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER, ASK NAV_HX05 - END_LP05
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS TIME PERIOD
COVERAGE DETAIL FOR RU MEMBERS COVERED BY
MEDICAID/SCHIP. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING
CONDITIONS:
- ESTABLISHMENT IS MEDICAID/SCHIP
AND
- PERSON IS FLAGGED AS COVERED BY MEDICAID/SCHIP
DURING THE CURRENT ROUND (I.E., SELECTED IN
HX11)
----------------------------------------------------

----------------------------------------------------
NAVIGATOR DETAILS: LOOP_05 USES NAV_HX05 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------


NAV_HX05
========

MEDICAID/SCHIP {STR-DT}

SERIES: Time Covered by MEDICAID/SCHIP during Reference Period.

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

RU Member

[1. Coverage duration for [Person’s Name-65] through
MEDICAID/SCHIP] [Status-25]
[2. Coverage duration for [Person’s Name-65] through
MEDICAID/SCHIP] [Status-25]
[3. Coverage duration for [Person’s Name-65] through
MEDICAID/SCHIP] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX11.
----------------------------------------------------

----------------------------------------------------
CONTINUE WITH BOX_13 FOR SELECTED RU MEMBER.
----------------------------------------------------


BOX_13
======

-----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION
FOR THIS PERSON.
-----------------------------------------------------

-----------------------------------------------------
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH
END_LP05
-----------------------------------------------------


END_LP05
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-
PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS
STATED IN THE LOOP DEFINITION.
----------------------------------------------------

----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS,
END LOOP_05 AND CONTINUE WITH BOX_14
----------------------------------------------------


BOX_14
======

----------------------------------------------------
IF TRICARE/CHAMPVA PROVIDED TO ANY RU MEMBER
DURING THE PREVIOUS ROUND, GO TO BOX_16
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH HX12
----------------------------------------------------


HX12
====

{STR-DT}
{END-DT}

At any time {since (START DATE)/between (START DATE) and
(END DATE)}, has anyone in the family been covered by TRICARE
or CHAMPVA?

YES .................................... 1 {HX12A}
NO ..................................... 2 {BOX_16}
REF ................................... -7 {BOX_16}
DK .................................... -8 {BOX_16}

HELP AVAILABLE FOR DEFINITION OF TRICARE/CHAMPVA.

----------------------------------------------------
DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.
DISPLAY ‘between (START DATE) and (END DATE)’ IF
ROUND 5.
----------------------------------------------------


HX12A
=====

{STR-DT}
{END-DT}

Which plan is it? Is it…

INTERVIEWER:
CODE MORE THAN ONE PLAN ONLY IF DIFFERENT RU MEMBERS
HAVE DIFFERENT PLANS.

CHECK ALL THAT APPLY.

TRICARE Standard; ...................... 1
TRICARE Prime; ......................... 2
TRICARE Extra; ......................... 3
TRICARE for Life; or ................... 4
CHAMPVA? ............................... 5

[Code All That Apply]

----------------------------------------------------
IF HX12 IS CODED ‘1’ (YES) AND SINGLE-PERSON RU,
SELECT PERSON AT HX13 AUTOMATICALLY BY CAPI AND
GO TO LOOP_06
----------------------------------------------------

----------------------------------------------------
IF HX12 IS CODED ‘1’ (YES) AND MULTI-PERSON RU,
CONTINUE WITH HX13
----------------------------------------------------


HX13
====
{STR-DT}
{END-DT}

Who is covered by TRICARE or CHAMPVA?

PROBE: Who else is covered by TRICARE or CHAMPVA?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]

----------------------------------------------------
GO TO LOOP_06
----------------------------------------------------

----------------------------------------------------
ROSTER DETAILS:
Title: RU_MEMBERS_1

COL #1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION
OF RU-MEMBERS.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT
FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------


LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER, ASK NAV_HX06 - END_LP06
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS TIME PERIOD
COVERAGE DETAIL FOR RU MEMBERS COVERED BY TRICARE
OR CHAMPVA. THIS LOOP CYCLES ON ESTABLISHMENT-
PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS TRICARE/CHAMPVA
AND
- PERSON IS FLAGGED AS COVERED BY TRICARE/CHAMPVA
DURING THE CURRENT ROUND (I.E., SELECTED AT
HX13)
----------------------------------------------------

----------------------------------------------------
NAVIGATOR DETAILS: LOOP_06 USES NAV_HX06 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------


NAV_HX06
========

TRICARE OR CHAMPVA {STR-DT}

SERIES: Time Covered by TRICARE OR CHAMPVA during Reference
Period.

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

RU Member

[1. Coverage duration for [Person’s Name-65] through
TRICARE OR CHAMPVA] [Status-25]
[2. Coverage duration for [Person’s Name-65] through
TRICARE OR CHAMPVA] [Status-25]
[3. Coverage duration for [Person’s Name-65] through
TRICARE OR CHAMPVA] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX13.
----------------------------------------------------

----------------------------------------------------
CONTINUE WITH BOX_15 FOR SELECTED RU MEMBER.
----------------------------------------------------


BOX_15
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION
FOR THIS PERSON.
----------------------------------------------------

----------------------------------------------------
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH
END_LP06
----------------------------------------------------


END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED
IN THE LOOP DEFINITION.
----------------------------------------------------

----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS,
END LOOP_06 AND CONTINUE WITH BOX_16
----------------------------------------------------


BOX_16
======

----------------------------------------------------
IF MEDICAID/SCHIP IS A SOURCE OF INSURANCE FOR
ANY RU MEMBER DURING CURRENT ROUND, GO TO BOX_19
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_17
----------------------------------------------------


BOX_17
======

----------------------------------------------------
IF GOVT-HOSPITAL/PHYSICIAN PROVIDED TO ANY RU
MEMBER DURING THE PREVIOUS ROUND, GO TO BOX_19
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH HX14
----------------------------------------------------


HX14
====

{STR-DT}
{END-DT}

At any time {since (START DATE)/between (START DATE) and
(END DATE)}, has anyone in the family had any other type of health
insurance from any state or local government agency which provided
hospital and physician benefits?

YES .................................... 1 {HX14A}
NO ..................................... 2 {BOX_19}
REF ................................... -7 {BOX_19}
DK .................................... -8 {BOX_19}

HELP AVAILABLE FOR DESCRIPTION OF INSURANCE TYPES TO INCLUDE.

----------------------------------------------------
DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.
DISPLAY ‘between (START DATE) and (END DATE)’ IF
ROUND 5.
----------------------------------------------------


HX14A
=====

{STR-DT}

What is the name of the plan?

[Enter text] ...........................

----------------------------------------------------
NOTE: ‘GOVT-HOSPITAL/PHYSICIAN’ SHOULD BE USED
FOR THE ESTABLISHMENT NAME IN THE CONTEXT HEADER
(WHERE APPROPRIATE).
----------------------------------------------------

----------------------------------------------------
IF HX14 IS CODED ‘1’ (YES) AND SINGLE-PERSON RU,
SELECT PERSON AT HX15 AUTOMATICALLY BY CAPI AND
GO TO LOOP_07
----------------------------------------------------

----------------------------------------------------
IF HX14 IS CODED ‘1’ (YES) AND MULTI-PERSON RU,
CONTINUE WITH HX15
----------------------------------------------------


HX15
====

{STR-DT}
{END-DT}

Who is covered by a program sponsored by a state or local
government agency which provided hospital and physician
benefits?

PROBE: Who else is covered by a program sponsored by a state
or local government agency which provided hospital and
physician benefits?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]

----------------------------------------------------
GO TO LOOP_07
----------------------------------------------------

----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION OF RU MEMBERS.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT
FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOLWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------


LOOP_07
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER, ASK NAV_HX07 - END_LP07
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_07 COLLECTS TIME PERIOD
COVERAGE DETAIL FOR RU MEMBERS COVERED BY GOVT-
HOSPITAL/PHYSICIAN. THIS LOOP CYCLES ON
ESTABLISHMENT-PERSON-PAIRS THAT MEET THE
FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
AND
- PERSON IS FLAGGED AS BEING COVERED BY GOVT-
HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND
(I.E., SELECTED AT HX15)
----------------------------------------------------

----------------------------------------------------
NAVIGATOR DETAILS: LOOP_07 USES NAV_HX07 TO
CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------


NAV_HX07
========

{PLAN NAME FROM HX14A.....} {STR-DT}

SERIES: Time Covered by {PLAN NAME FROM HX14A.....} during
Reference Period.

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

RU Member

[1. Coverage duration for [Person’s Name-65] through
{PLAN NAME FROM HX14A.....}] [Status-25]
[2. Coverage duration for [Person’s Name-65] through
{PLAN NAME FROM HX14A.....}] [Status-25]
[3. Coverage duration for [Person’s Name-65] through
{PLAN NAME FROM HX14A.....}] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX15.
----------------------------------------------------

----------------------------------------------------
CONTINUE WITH BOX_18 FOR SELECTED RU MEMBER.
----------------------------------------------------


BOX_18
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION
FOR THIS PERSON.
----------------------------------------------------

----------------------------------------------------
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH
END_LP07
----------------------------------------------------


END_LP07
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-
PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS
STATED IN THE LOOP DEFINITION.
----------------------------------------------------

----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS,
END LOOP_07 AND CONTINUE WITH BOX_19
----------------------------------------------------


BOX_19
======

----------------------------------------------------
IF ANY TYPE OF OTHER PUBLIC INSURANCE PROVIDED TO
ANY RU MEMBER AT ANY TIME DURING THE PREVIOUS
ROUND, GO TO HX21
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH HX16
----------------------------------------------------


HX16
====

{STR-DT}
{END-DT}

Some people receive health benefits from other state programs such
as (READ PROGRAM NAMES BELOW) or other public programs that provide
coverage for health care services.

{STATE NAME FOR PROGRAM #1..................}
{STATE NAME FOR PROGRAM #2..................}
{STATE NAME FOR PROGRAM #3..................}
{STATE NAME FOR PROGRAM #4..................}

At any time {since (START DATE)/between (START DATE) and (END
DATE)}, has anyone in the family been covered by any program like
this?

YES .................................... 1 {LOOP_08}
NO ..................................... 2 {HX21}
REF ................................... -7 {HX21}
DK .................................... -8 {HX21}

HELP AVAILABLE FOR A LIST OF OTHER STATE PROGRAMS.

----------------------------------------------------
DISPLAY THE LIST OF UP TO FOUR ACTUAL NAMES OF
STATE PROGRAMS (AS LISTED IN ATTACHMENT 37) FOR
‘STATE NAME FOR PROGRAM #N’ IF STATE HAS OTHER
STATE PROGRAMS. OTHERWISE, USE A NULL DISPLAY.

DISPLAY ‘since (START DATE)’ IF NOT ROUND 5.
DISPLAY ‘between (START DATE) and (END DATE)’ IF
ROUND 5.
----------------------------------------------------


LOOP_08
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

GROUP 1
GROUP 2

ASK BOX_20-END_LP08
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_08 COLLECTS INFORMATION ON
OTHER STATE OR PUBLIC PROGRAMS. THE FIRST CYCLE
OF THIS LOOP COLLECTS GROUP 1 OTHER PUBLIC
INSURANCE PROGRAMS OR, IF NO GROUP 1, GROUP 2
OTHER PUBLIC INSURANCE PROGRAMS.

THIS LOOP CAN CYCLE A MAXIMUM OF TWICE. THE
SUBSEQUENT CYCLE OF THE LOOP IS DETERMINED BY THE
RESPONSE AT HX20. IF HX20 IS CODED ‘1’ (YES),
THE LOOP CYCLES AGAIN TO COLLECT GROUP 2 PUBLIC
INSURANCE INFORMATION. IF HX20 IS CODED ‘2’ (NO),
‘-7’ (REFUSED), ‘-8’ (DON’T KNOW), OR IS NOT
ASKED, THE LOOP ENDS.
----------------------------------------------------


BOX_20
======

----------------------------------------------------
IF FIRST CYCLE OF LOOP_08, CONTINUE WITH HX17
----------------------------------------------------

----------------------------------------------------
OTHERWISE (I.E., IF SECOND CYCLE OF LOOP_08), GO
TO HX18
----------------------------------------------------


HX17
====

{STR-DT}
{END-DT}

What is the name of the program?

PROBE: Any other state program?

NOTE: IF ONLY TANF, SSI, WIC, IHS, PUBLIC HEALTH CLINIC, OR VA
IS MENTIONED, CODE 95.

{STATE SPECIFIC PLAN 1} ................ 1
{STATE SPECIFIC PLAN 2} ................ 2
{STATE SPECIFIC PLAN 3} ................ 3
{STATE SPECIFIC PLAN 4} ................ 4
OTHER ................................. 91 {HX17OV}
NONE OF THESE ......................... 95 {HX18}
REF ................................... -7 {BOX_21}
DK .................................... -8 {BOX_21}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

[Code All That Apply]

----------------------------------------------------
FOR ‘STATE SPECIFIC PLAN N’, DISPLAY AN ACTUAL
NAME OF A STATE PLAN WHEN INTERVIEW IS BEING
CONDUCTED IN A STATE THAT HAS OTHER STATE
PROGRAMS. FOR THE SPECIFIC NAMES OF PROGRAMS BY
STATE, SEE ATTACHMENT 37.
----------------------------------------------------

----------------------------------------------------
ANY PROGRAM SELECTED IN HX17 IS CONSIDERED A GROUP
1 PROGRAM AND WILL BE GROUPED TOGETHER WHEN ASKED
ABOUT IN HX19.
----------------------------------------------------

----------------------------------------------------
CODES ‘1’, ‘2’, ‘3’, ‘4’, ‘5’, AND ‘6’ ARE
RESERVED FOR STATE SPECIFIC PLANS. IF THE STATE
HAS LESS THAN 6 PLANS, DO NOT ADJUST THE OTHER
CODES. (I.E., FOR A STATE WITH NO STATE-SPECIFIC
PLANS, CODES WOULD START WITH ‘91’ AT HX17 OR ‘7’
AT HX18.)
----------------------------------------------------

----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT
ALLOW ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW) IN
COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------

----------------------------------------------------
IF CODED ‘91’ (OTHER), ALONE OR IN COMBINATION
WITH ANY OTHER CODE, CONTINUE WITH HX17OV
----------------------------------------------------

----------------------------------------------------
IF CODED ‘95’ (NONE OF THESE), GO TO HX18
----------------------------------------------------

----------------------------------------------------
OTHERWISE, GO TO BOX_21
----------------------------------------------------

----------------------------------------------------
HARD CHECK:
EDIT: CODE ‘95’ (NONE OF THESE) CANNOT BE ENTERED
WITH ANY OTHER CODES. IF CODED ‘95’ (NONE OF
THESE) WITH ANY OTHER CODES, DISPLAY THE
FOLLOWING MESSAGE: "95 CANNOT BE CODED WITH ANY
OTHER RESPONSES. VERIFY AND RE-ENTER. CONTINUE."
----------------------------------------------------


HX17OV
======

SPECIFY:

[Enter Other Specify] .................. {BOX_21}
REF ................................... -7 {BOX_21}
DK .................................... -8 {BOX_21}


HX18
====

{STR-DT}
{END-DT}

What is the name of the program?

PROBE: Any other state program?

TANF (TEMPORARY ASSISTANCE FOR NEEDY
FAMILIES) .............................. 7
SSI (SUPPLEMENTAL SECURITY INCOME) ..... 8
WIC (WOMEN, INFANTS AND CHILDREN) ...... 9
IHS (INDIAN HEALTH SERVICE) ........... 10
PUBLIC HEALTH CLINIC .................. 11
VA (VETERANS ADMINISTRATION) .......... 12
REF ................................... -7 {END_LP08}
DK .................................... -8 {END_LP08}

HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

[Code All That Apply]

----------------------------------------------------
ANY PROGRAM SELECTED IN HX18 IS CONSIDERED A
GROUP 2 PROGRAM AND WILL BE GROUPED TOGETHER WHEN
ASKED ABOUT IN HX19
----------------------------------------------------

----------------------------------------------------
IF:
NO CURRENT RU MEMBER COVERED BY MEDICAID OR GOVT-
HOSPITAL/PHYSICIAN DURING CURRENT ROUND
AND
HX18 IS CODED ‘7’ (TANF), ‘8’ (SSI), OR ‘9’
(WIC), ALONE OR WITH ANY OTHER COMBINATION OF
CODES, CONTINUE WITH BOX_21
----------------------------------------------------

----------------------------------------------------
OTHERWISE, GO TO END_LP08
----------------------------------------------------


BOX_21
======

----------------------------------------------------
IF SINGLE-PERSON RU, SELECT PERSON AT HX19
AUTOMATICALLY BY CAPI AND GO TO LOOP_09
----------------------------------------------------

----------------------------------------------------
IF MULTI-PERSON RU, CONTINUE WITH HX19
----------------------------------------------------


HX19
====

{STR-DT}
{END-DT}

PROGRAM:
{STATE PROGRAM PROVIDING COVERAGE}
{STATE PROGRAM PROVIDING COVERAGE}
{STATE PROGRAM PROVIDING COVERAGE}
{STATE PROGRAM PROVIDING COVERAGE}

Who is covered by (READ PROGRAMS ABOVE)?

PROBE: Who else is covered by (READ PROGRAMS ABOVE)?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]

----------------------------------------------------
IF COMING FROM HX17, DISPLAY ALL PROGRAMS SELECTED
AT HX17. IF COMING FROM HX18, DISPLAY ALL
PROGRAMS SELECTED AT HX18.
----------------------------------------------------

----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION OF RU MEMBERS.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT
FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOLWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------


LOOP_09
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON-
PAIRS ROSTER, ASK BOX_21A - END_LP09
----------------------------------------------------

----------------------------------------------------
LOOP DEFINITION: LOOP_09 COLLECTS TIME PERIOD
COVERAGE DETAIL FOR RU MEMBERS COVERED BY OTHER
PUBLIC PROGRAMS. THIS LOOP CYCLES ON ESTABLISHMENT
-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 1 OR GROUP 2 OTHER
PUBLIC PROGRAM
AND
- PERSON IS FLAGGED AS BEING COVERED BY GROUP 1
OR GROUP 2 OTHER PUBLIC PROGRAM DURING THE
CURRENT ROUND (I.E., SELECTED IN HX19)
----------------------------------------------------

----------------------------------------------------
NAVIGATOR DETAILS: LOOP_09 USES EITHER NAV_HX09A
OR NAV_HX09B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------


BOX_21A
=======

----------------------------------------------------
IF FIRST TIME THROUGH LOOP_08 AND HX17 IS NOT
CODED ‘95’ (NONE OF THESE), THIS LOOP CYCLES ON A
ESTABLISHMENT-PERSON-PAIR WHERE ESTABLISHMENT IS A
GROUP 1 OTHER PUBLIC PROGRAM. CONTINUE WITH
NAV_HX09A
----------------------------------------------------

----------------------------------------------------
IF HX17 IS CODED ‘95’ (NONE OF THESE) OR IF SECOND
CYCLE OF LOOP_08, THEN THE ESTABLISHMENT IS A
GROUP 2 OTHER PUBLIC PROGRAM. GO TO NAV_HX09B
----------------------------------------------------


NAV_HX09A
=========

STATE SPECIFIC PROGRAM {STR-DT}

SERIES: Time Covered by STATE SPECIFIC PROGRAM during Reference
Period.

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

RU Member

[1. Coverage duration for [Person’s Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]
[2. Coverage duration for [Person’s Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]
[3. Coverage duration for [Person’s Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX19 AND
FLAGGED AS BEING COVERED BY A GROUP 1 OTHER PUBLIC
PROGRAM DURING THE CURRENT ROUND.
----------------------------------------------------

----------------------------------------------------
GO TO BOX_22 FOR SELECTED RU MEMBER.
----------------------------------------------------


NAV_HX09B
=========

STATE: TANF/SSI/WIC/IHS/PHC/VA {STR-DT}

SERIES: Time Covered by STATE: TANF/SSI/WIC/IHS/PHC/VA during
Reference Period.

USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.

WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO
PAST THIS SERIES.

IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS
SERIES.

RU Member

[1. Coverage duration for [Person’s Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]
[2. Coverage duration for [Person’s Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]
[3. Coverage duration for [Person’s Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]

----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
----------------------------------------------------

----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON-
PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------

----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------

----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX19 AND
FLAGGED AS BEING COVERED BY A GROUP 2 OTHER PUBLIC
PROGRAM DURING THE CURRENT ROUND.
----------------------------------------------------

----------------------------------------------------
GO TO BOX_22 FOR SELECTED RU MEMBER
----------------------------------------------------


BOX_22
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION
FOR THIS PERSON.
----------------------------------------------------

----------------------------------------------------
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH
END_LP09
----------------------------------------------------


END_LP09
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-
PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS
STATED IN THE LOOP DEFINITION.
----------------------------------------------------

----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS,
END LOOP_09 AND CONTINUE WITH BOX_23
----------------------------------------------------


BOX_23
======

----------------------------------------------------
IF HX17 IS CODED ‘95’ (NONE OF THESE) OR IF ON
SECOND CYCLE OF LOOP_08, GO TO END_LP08
----------------------------------------------------

----------------------------------------------------
OTHERWISE, CONTINUE WITH HX20
----------------------------------------------------


HX20
====

{STR-DT}
{END-DT}

Are there any other state programs that provide coverage for
health care services to anyone else in the family?

YES .................................... 1 {END_LP08}
NO ..................................... 2 {END_LP08}
REF ................................... -7 {END_LP08}
DK .................................... -8 {END_LP08}


END_LP08
========

----------------------------------------------------
IF HX20 IS CODED ‘1’ (YES), CYCLE TO COLLECT GROUP
2 PUBLIC INSURANCE INFORMATION.
----------------------------------------------------

----------------------------------------------------
IF HX20 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), ‘-8’
(DON’T KNOW), OR IS NOT ASKED, END LOOP_08 AND
CONTINUE WITH HX21
----------------------------------------------------


HX21
====

{STR-DT}
{END-DT}

Next, I have some questions about other sources of health insurance
anyone in the family may have had {since (START DATE)/between (START
DATE) and (END DATE)} to help pay hospital and doctor bills and other
health expenses such as nursing home care or prescribed medicines.
{This includes Medigap or Medicare Supplements, plans through a
private insurance carrier, which some people who are eligible for
Medicare have as additional coverage.}

{Since (START DATE)/Between (START DATE) and (END DATE)} we show the
family has had the following health insurance:

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