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 (E.G. 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}
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}
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_HX01B FOR SELECTED RU MEMBER NAV_HX01B
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
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
IF ROUND 1 THROUGH ROUND 4, DISPLAY ‘at some point after {START DATE}’. IF ROUND 5, DISPLAY ‘between {START DATE} and {END DATE}’.
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
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.
STARTING IN PANEL 17 ROUND 5, PANEL 18 ROUND 3 AND PANEL 19 ROUND 1, CATEGORY ‘11’ (DIRECTLY FROM {STATE EXCHANGE NAME}) WAS ADDED AND WILL BE ADDED IN ALL FUTURE ROUNDS.
DISPLAY ‘you mentioned that {you/{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. FOR ‘STATE EXCHANGE NAME’ DISPLAY THE EXCHANGE NAME ‘A’ ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED. HX03OV
OTHER: 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 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}
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}
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}
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}
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
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} HX09
{PERSON’S FIRST MIDDLE AND LAST NAME} 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}
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 36.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS SUBSTITUTING THE REAL NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
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}
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 36.
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 DISALLOWED.
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}
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 HX11A HX11A
{STR-DT}
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 36.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS SUBSTITUTING THE REAL NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
DISPLAY ‘, [which may also be known as {ALIAS B} {or {ALIAS C}}]’ IF THERE IS MORE THAN ONE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
DISPLAY ‘or {ALIAS C}’ IF THERE ARE THREE EXCHANGE NAMES ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
FOR ‘STATE EXCHANGE NAME-A’, ‘ALIAS B’, AND ‘ALIAS C’, DISPLAY THE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED. 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}
DISPLAY ‘since {START DATE}’ IF NOT ROUND 5. DISPLAY ‘between {START DATE} and {END DATE}’ IF ROUND 5. HX12A
{STR-DT}
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}
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}
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}
DISPLAY ‘since {START DATE}’ IF NOT ROUND 5. DISPLAY ‘between {START DATE} and {END DATE}’ IF ROUND 5. HX14A
{STR-DT}
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}
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 DISALLOWED.
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}
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 HX15A HX15A
{STR-DT}
DISPLAY ‘, [which may also be known as {ALIAS B} {or {ALIAS C}}]’ IF THERE IS MORE THAN ONE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
DISPLAY ‘or {ALIAS C}’ IF THERE ARE THREE EXCHANGE NAMES ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
FOR ‘STATE EXCHANGE NAME-A’, ‘ALIAS B’, AND ‘ALIAS C’,’ DISPLAY THE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED. 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}
DISPLAY THE LIST OF UP TO FOUR ACTUAL NAMES OF STATE PROGRAMS (AS LISTED IN ATTACHMENT 36) 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}
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 36.
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: HX18
{STR-DT}
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}
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 DISALLOWED.
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}
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}
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_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}
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY ‘This includes...coverage.’ IF ANYONE IN RU HAS MEDICARE AS A SOURCE OF INSURANCE DURING THE CURRENT ROUND. DISPLAY ‘since {START DATE}’ IF NOT ROUND 5. DISPLAY ‘between {START DATE} and {END DATE}’ IF ROUND 5. DISPLAY ‘Since {START DATE}, ... following health insurance:’ AND THE REPORT OF CURRENT ROUND HEALTH INSURANCE IF ANY SOURCES OF INSURANCE ARE RECORDED FOR THIS RU. HX22
{STR-DT}
DISPLAY ‘Not counting insurance you already told me about, at’ AND ‘other’ IF ANY SOURCES OF INSURANCE ARE RECORDED FOR THIS RU. IF NO SOURCES OF INSURANCE ARE RECORDED FOR THIS RU, DISPLAY ‘At’. DISPLAY ‘since {START DATE}’ IF NOT ROUND 5. DISPLAY ‘between {START DATE} and {END DATE}’ IF ROUND 5. LOOP_10
FOR EACH OF THE FOLLOWING: PRIVATELY PURCHASED INSURANCE CATEGORY 1 PRIVATELY PURCHASED INSURANCE CATEGORY 2 PRIVATELY PURCHASED INSURANCE CATEGORY 3 PRIVATELY PURCHASED INSURANCE CATEGORY 4 PRIVATELY PURCHASED INSURANCE CATEGORY 5 PRIVATELY PURCHASED INSURANCE CATEGORY 6 ASK HX23 - END_LP10
LOOP DEFINITION: LOOP_10 COLLECTS INFORMATION ABOUT PRIVATELY PURCHASED HEALTH INSURANCE OBTAINED FROM SOURCES OTHER THAN EMPLOYERS MENTIONED IN THE EMPLOYMENT SECTION OF THE INTERVIEW. THIS LOOP CYCLES ON SOURCES OF PRIVATELY PURCHASED INSURANCE LISTED AT HX23. THE FIRST CYCLE OF THIS LOOP COLLECTS THE FIRST SOURCE OF PRIVATELY PURCHASED INSURANCE. SUBSEQUENT CYCLES OF THE LOOP ARE DETERMINED BY THE RESPONSE AT HX24. IF HX24 IS CODED ‘1’ (YES), THE LOOP CYCLES AGAIN TO COLLECT THE NEXT SOURCE OF PRIVATELY PURCHASED INSURANCE. IF HX24 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW), THE LOOP ENDS. HX23
{STR-DT}
STARTING IN PANEL 12 ROUND 2, CATEGORY ‘2’ (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 ‘13’ (DIRECTLY FROM A HIGH RISK POOL {/{STATE NAME FOR HIGH RISK POOL}}) WAS ADDED AS A CATEGORY AND WILL BE ADDED IN ALL FUTURE ROUNDS.
STARTING IN PANEL 17 ROUND 5, PANEL 18 ROUND 3 AND PANEL 19 ROUND 1, CATEGORY ‘14’ (DIRECTLY FROM {STATE EXCHANGE NAME} WAS ADDED AND WILL BE ADDED IN ALL FUTURE ROUNDS.
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. FOR ‘STATE EXCHANGE NAME’ DISPLAY THE EXCHANGE NAME ‘A’ ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
DISPLAY AN ‘ADD OTHER SOURCE’ BUTTON ON THIS SCREEN.
IF ‘ADD OTHER SOURCE’ IS SELECTED, PRESENT ‘ADD OTHER SOURCE’ POP-UP (HX23OV) AND THEN GO TO BOX_24. HX23OV
ENTER OTHER: BOX_24
ASK PRIVATE HEALTH INSURANCE DETAIL (HP) SECTION FOR THE RESPONSE CATEGORY SELECTED AT HX23 AND FLAGGED THIS ROUND AS PROVIDING HEALTH INSURANCE.
AT COMPLETION OF THE HP SECTION, CONTINUE WITH HX24 HX24
{STR-DT}
DISPLAY ‘since {START DATE}’ IF NOT ROUND 5. DISPLAY ‘between {START DATE} and {END DATE}’ IF ROUND 5. END_LP10
IF HX24 IS CODED ‘1’ (YES), CYCLE TO COLLECT THE NEXT INSURANCE CATEGORY.
OTHERWISE END LOOP_10, AND CONTINUE WITH BOX_25 BOX_25
IF NO PUBLIC OR PRIVATE INSURANCE RECORDED FOR ANY CURRENT RU MEMBER, GO TO BOX_45
OTHERWISE, CONTINUE WITH BOX_26 BOX_26
IF ANY RU MEMBER HAS MEDICARE AS A SOURCE OF INSURANCE DURING THE CURRENT ROUND, CONTINUE WITH BOX_27
OTHERWISE, GO TO BOX_29 BOX_27
IF ROUND 1, GO TO LOOP_11
OTHERWISE, CONTINUE WITH BOX_28 BOX_28
IF NOT ROUND 1, CONTINUE WITH LOOP_11 ONLY FOR RU MEMBERS WHERE MEDICARE WAS RECORDED AS BEING RECEIVED THIS ROUND. THAT IS, CONTINUE WITH LOOP_11 ONLY IF THERE IS AT LEAST ONE ESTABLISHMENT-PERSON-PAIR WHERE THE ESTABLISHMENT IS MEDICARE AND THE PAIR WAS CREATED THIS ROUND.
OTHERWISE, GO TO BOX_29 LOOP_11
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK HX25-END_LP11
LOOP DEFINITION: LOOP_11 COLLECTS MEDICARE CARD AND MANAGED CARE INFORMATION FOR RU MEMBERS COVERED BY MEDICARE. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS: IF ROUND 1: - ESTABLISHMENT IS MEDICARE AND - PERSON IS AN RU MEMBER FLAGGED AS COVERED BY MEDICARE DURING THE ROUND IF NOT ROUND 1: - ESTABLISHMENT IS MEDICARE AND - PERSON IS AN RU MEMBER AND - ESTABLISHMENT-PERSON-PAIR WAS CREATED THIS ROUND HX25
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
STARTING IN PANEL 13 ROUND 1/PANEL 12 ROUND 3, CAPI NO LONGER COLLECTS MEDICARE NUMBERS (SSN). HX26
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
NOTE: INTERVIEWERS WILL BE TRAINED TO CODE ANY TYPE OF MANAGED CARE CARD COLLECTED HERE AS SOME OTHER CARD.
IF CODED ‘1’ (MEDICARE CARD) OR ‘2’ (RAILROAD RETIREMENT BOARD CARD), CONTINUE WITH HX27
IF CODED ‘3’ (SOME OTHER CARD) ONLY, GO TO HX28A HX27
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
STARTING IN PANEL 13, ROUND 1/PANEL 12, ROUND 3, CAPI NO LONGER COLLECTS MEDICARE NUMBERS (SSN).
GO TO HX32
HARD CHECK: CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., < OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, FLAG RU MEMBER AS ‘WITH HEALTH INSURANCE COVERAGE ON JAN 1, {YEAR}’.
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR > BIRTH DATE OF PERSON. HX28A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} HX29
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
IF EFFECTIVE DATE IS: - A VALID DATE (I.E., NOT ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) IN THE MONTH OR YEAR FIELDS AND - ON OR BEFORE JANUARY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, THEN FLAG RU MEMBER AS ‘WITH HEALTH INSURANCE COVERAGE ON JAN 1, {YEAR}.
HARD CHECK: DATE MUST BE ON OR BEFORE (I.E., < OR =) INTERVIEW DATE OR 12/31/{YEAR}, WHERE YEAR IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. ‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS. MEDICARE EFFECTIVE DATE MUST BE = OR > BIRTH DATE OF PERSON. HX29OV
Did {you/he/she} have Medicare coverage on January 1,
{YEAR}?
IF HX29OV CODED ‘1’ (YES), FLAG PERSON AS ‘WITH HEALTH INSURANCE COVERAGE ON JAN 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL. HX30
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} HX32
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘{Are/Is} {you/{PERSON} currently’ IF NOT ROUND 5. DISPLAY ‘as of {END DATE}, {were/was} {you/{PERSON}’ IF ROUND 5. HX33
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘is’ IF NOT ROUND 5. DISPLAY ‘was’ IF ROUND 5. DISPLAY ‘as of {END DATE}’ IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
FLAG INSURER CODED ABOVE AS ‘CURRENT ROUND’S MEDICARE INSURER’ FOR THIS ESTABLISHMENT-PERSON- PAIR. HX33A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘{Do/Does}’ IF NOT ROUND 5. DISPLAY ‘Did’ IF ROUND 5. DISPLAY ‘{NAME OF PLAN FROM HX33}’ IF A PLAN NAME WAS CODED AT HX33. DISPLAY ‘{your/his/her} Medicare managed care plan’ IF HX33 IS CODED ‘-7’ (REF) OR ‘-8’ (DK). DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR ‘NAME OF PLAN FROM HX33’ IF A PLAN NAME WAS ENTERED. DISPLAY ‘as of {END DATE}’ IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX34
OTHERWISE, GO TO END_LP11 HX34
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘the coverage with {NAME OF PLAN FROM HX33}’ IF A MEDICARE PLAN NAME WAS ENTERED AT HX33. DISPLAY ‘this Medicare managed care plan’ IF HX33 WAS CODED ‘-7’ (REF) OR ‘-8’ (DK). DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR ‘NAME OF PLAN FROM HX33’ IF A PLAN NAME WAS ENTERED. HX34A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘{NAME OF PLAN FROM HX33}’ IF A MEDICARE PLAN NAME WAS ENTERED AT HX33. DISPLAY ‘Medicare managed care’ IF HX33 WAS CODED ‘-7’ (REF) OR ‘-8’ (DK). DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR ‘NAME OF PLAN FROM HX33’ IF A PLAN NAME WAS ENTERED. HX35
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘is {your/{PERSON}’s} Social Security deduction’ IF HX34A IS CODED ‘1’ (DEDUCTED FROM SOCIAL SECURITY’. DISPLAY ‘{do/does} {you/ {PERSON}} pay in premiums’ IF HX34A IS CODED ‘2’ (PAY DIRECTLY) OR ‘3’ (BOTH).
DISPLAY ‘{NAME OF PLAN FROM HX33}’ IF A MEDICARE PLAN NAME WAS ENTERED AT HX33. OTHERWISE (I.E., IF HX33 WAS CODED ‘-7’ (REF) OR ‘-8’ (DK)), USE A NULL DISPLAY. DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR ‘NAME OF PLAN FROM HX33’ IF A PLAN NAME WAS ENTERED. HX35OV1
Is that per year, per month, per week, or what? HX35OV2
SPECIFY: HX35AA
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘PLAN NAME: {NAME OF PLAN FROM HX33}’ IF A MEDICARE PLAN NAME WAS ENTERED AT HX33. OTHERWISE (I.E., IF HX33 WAS CODED ‘-7’ (REF) OR ‘-8’ (DK)), USE A NULL DISPLAY. DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR ‘NAME OF PLAN FROM HX33’ IF A PLAN NAME WAS ENTERED. HX35A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘{Are/Is}’ IF NOT ROUND 5. DISPLAY ‘{Were/Was}’ IF ROUND 5. DISPLAY ‘as of {END DATE}’ IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
IF CODED ‘1’ (YES) AND ROUND 1 OR ROUND 3, CONTINUE WITH HX35B
OTHERWISE, GO TO END_LP11 HX35B
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} HX35C
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} HX35D
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
DISPLAY ‘is {your/{PERSON}’s} Social Security deduction’ IF HX35C IS CODED ‘1’ (DEDUCTED FROM SOCIAL SECURITY’. DISPLAY ‘{do/does} {you/ {PERSON}} pay in premiums’ IF HX35C IS CODED ‘2’ (PAY DIRECTLY) OR ‘3’ (BOTH). HX35DOV1
Is that per year, per month, per week, or what? HX35DOV2
SPECIFY: HX35E
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT} END_LP11
CYCLE ON NEXT PAIR ON RE-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_11 AND CONTINUE WITH BOX_29 BOX_29
IF ANY RU MEMBER HAS MEDICAID/SCHIP OR GOVT- HOSPITAL/PHYSICIAN AS A SOURCE OF INSURANCE DURING THE CURRENT ROUND, CONTINUE WITH BOX_30
OTHERWISE, GO TO BOX_32 BOX_30
IF NO ONE IN THE RU WAS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE PREVIOUS ROUND AND AT LEAST ONE RU MEMBER IS COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND OR IF NO ONE IN THE RU WAS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE PREVIOUS ROUND AND AT LEAST ONE RU MEMBER IS COVERED BY GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND, CONTINUE WITH HX42
OTHERWISE, GO TO BOX_32
NOTE: SINCE AN RU CANNOT HAVE BOTH MEDICAID/SCHIP AND GOVT-HOSPITAL/PHYSICIAN, HX42-HX46B WILL BE ASKED ONLY ONCE; EITHER FOR A ‘YES’ TO HX10 (MEDICAID/SCHIP) OR A ‘YES’ TO HX14 (GOVT- HOSPITAL/PHYSICIAN). HX42
{STR-DT}
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}’ IF ASKING ABOUT MEDICAID/ SCHIP. DISPLAY ‘the program....benefits’ IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN.
DISPLAY ‘(are/is)’ IF NOT ROUND 5. DISPLAY ‘(were/was)’ IF ROUND 5.
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 THE 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 36.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
DISPLAY ‘between {START DATE} and {END DATE}’ IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
ROSTER DETAILS: TITLE: RU_ESTB_PERS_PAIRS_1 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU MEMBERS.
ROSTER BEHAVIOR: 1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: 1. ESTABLISHMENT IS MEDICAID/SCHIP OR GOVT- HOSPITAL/PHYSICIAN, AND 2. PERSON IS AN RU MEMBER FLAGGED AS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND. HX43
{STR-DT}
DISPLAY ‘Does’ IF NOT ROUND 5. DISPLAY ‘Between {START DATE} and {END DATE}, did’ IF ROUND 5.
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}’ IF ASKING ABOUT MEDICAID/SCHIP. DISPLAY ‘the program....benefits’ IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN.
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 THE 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 36.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
IF CODED ‘3’ (NO, NONE REQUIRED), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW), THERE IS NO INSURER ASSOCIATED WITH THE CURRENT ROUND FOR MEDICAID/ SCHIP OR GOVT-HOSPITAL/PHYSICIAN.
IF CODED ‘3’ (NO, NONE REQUIRED), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW) AND IF ASKING ABOUT MEDICAID/ SCHIP, GO TO HX45
IF CODED ‘3’ (NO, NONE REQUIRED), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW) AND ASKING ABOUT GOVT- HOSPITAL/PHYSICIAN, GO TO HX45
OTHERWISE, (I.E., IF CODED ‘1’ (YES, ALL REQUIRED) OR ‘2’ (YES, SOME REQUIRED)), CONTINUE WITH HX44
ROSTER DETAILS: TITLE: RU_ESTB_PERS_PAIRS_1 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
ROSTER BEHAVIOR: 1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: 1. ESTABLISHMENT IS MEDICAID/SCHIP OR GOVT- HOSPITAL/PHYSICIAN, AND 2. PERSON IS AN RU MEMBER FLAGGED AS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND. HX44
{STR-DT}
DISPLAY ‘{Medicaid/{STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}’ IF ASKING ABOUT MEDICAID/ SCHIP. IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN, USE A NULL DISPLAY. DISPLAY ‘from the....benefits’ IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN. IF ASKING ABOUT MEDICAID/ SCHIP, USE A NULL DISPLAY. DISPLAY ‘HMO’ IF HX42 IS CODED ‘1’ (YES, ALL ARE) OR ‘2’ (YES, SOME ARE). DISPLAY ‘health insurance’ IF HX43 IS CODED ‘1’ (YES, ALL REQUIRED) OR ‘2’ (YES, SOME REQUIRED).
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 THE 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 36.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
FLAG INSURER CODED ABOVE AS CURRENT ROUND’S INSURER FOR MEDICAID/SCHIP OR GOVT-HOSPITAL/ PHYSICIAN.
CONTINUE WITH HX45 HX45
{STR-DT}
DISPLAY ‘{NAME OF PLAN FROM HX44}’ IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY, {{Medicaid/... and physician benefits}’. DISPLAY ‘{Medicaid/ {STATE NAME FOR MEDICAID}} or {STATE CHIP NAME}’ IF ASKING ABOUT MEDICAID/SCHIP. DISPLAY ‘the program ... benefits’ IF ASKING ABOUT GOVT- HOSPITAL/PHYSICIAN. DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR ‘NAME OF PLAN FROM HX44’ IF A PLAN NAME WAS ENTERED. DISPLAY ‘for anyone in the family’ IF MORE THAN ONE RU MEMBER SELECTED AS COVERED BY MEDICAID/ SCHIP OR GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, USE A NULL DISPLAY.
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 THE 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 36.
DISPLAY ‘or STATE CHIP NAME’ UNDER ALL CONDITIONS (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
IF CODED ‘1’ (YES, EVERYONE COVERED PAYS) AT HX45 (HOME.PRMEDPRE), CODE PRND.MEDGOVP FOR EACH PERSON IN THE ROSTER AT HX45A AS ‘1’ (PAYS FOR COVERAGE DURING THE CURRENT ROUND.) IF CODED ‘3’ (NO, NO ONE COVERED PAYS) AT HX45 (HOME.PRMEDPRE), CODE PRND.MEDGOVP FOR EACH PERSON IN THE ROSTER AT HX45A AS ‘2’ (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND.) IF CODED -7 OR -8 OR SET TO -9 (WHETHER EVERYONE IS COVERED IS MISSING) AT HX45 (HOME.PRMEDPRE), CODE PRND.MEDGOVP EQUAL TO THE MISSING VALUE IN HOME.PRMEDPRE FOR EACH PERSON IN THE HX45A ROSTER. LEAVE PRND.MEDGOVP BLANK (NO VALUE) FOR ANY RU MEMBER NOT ON THE ROSTER AT HX45A. THE HX45A ROSTER INCLUDES ALL PERSONS WITH MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN PROGRAM COVERAGE (EPRS.MCAID = 1 OR EPRS.GOVTPROG = 1) IN THE CURRENT RU FOR THE CURRENT ROUND. HX45A
{STR-DT}
CONTINUE WITH BOX_31
ROSTER DETAILS: TITLE: RU_ESTB_PERS_PAIRS_1 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
ROSTER BEHAVIOR: 1. MULTIPLE SELECT ALLOWED. 2. ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: 1. ESTABLISHMENT IS MEDICAID/SCHIP OR GOVT- HOSPITAL/PHYSICIAN, AND 2. PERSON IS AN RU MEMBER FLAGGED AS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND.
THE HX45A ROSTER INCLUDES ALL PERSONS WITH MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN PROGRAM COVERAGE (EPRS.MCAID = 1 OR EPRS.GOVTPROG = 1) IN THE CURRENT RU FOR THE CURRENT ROUND. CODE PRND.MEDGOVP AS ‘1’ (PAYS FOR COVERAGE DURING THE CURRENT ROUND) FOR ALL PERSONS FROM THE HX45A ROSTER WHO ARE SELECTED. CODE PRND.MEDGOVP AS ‘2’ (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND) FOR ALL PERSONS ON THE HX45A ROSTER WHO ARE NOT SELECTED. LEAVE PRND.MEDGOVP BLANK (NO VALUE) FOR ANY RU MEMBER NOT ON THE ROSTER AT HX45A. BOX_31
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX46
OTHERWISE, GO TO HX46B HX46
{STR-DT}
DISPLAY ‘the {NAME OF PLAN FROM HX44}’ IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY, ‘that’. DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR ‘NAME OF PLAN FROM HX44’ IF A PLAN NAME WAS ENTERED. HX46OV1
Is that per year, per month, per week, or what? HX46OV2
SPECIFY: HX46B
{STR-DT}
DISPLAY ‘PLAN NAME: ...’ IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, USE A NULL DISPLAY. DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR ‘NAME OF PLAN FROM HX44’ IF A PLAN NAME WAS ENTERED. BOX_31C
IF GOVERNMENT-HOSPITAL PHYSICIAN, CONTINUE WITH BOX_31D
OTHERWISE, GO TO BOX_32 BOX_31D
IF HX15A IS CODED ‘1’ (YES, PLAN IS EXCHANGE) AND HX45 IS CODED ‘1’ (YES, EVERYONE COVERED PAYS) OR ‘2’ (YES, SOME COVERED PAY), CONTINUE WITH HX47
OTHERWISE, GO TO BOX_32 HX47
{STR-DT}
DISPLAY ‘the {NAME OF PLAN FROM HX44} plan’ IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY ‘this plan.’ DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR ‘{NAME OF PLAN FROM HX44}’ IF A PLAN NAME WAS ENTERED. BOX_32
IF ANY ESTABLISHMENT RECORDED AS PROVIDING PRIVATE
INSURANCE (THAT WAS CREATED DURING THE CURRENT ROUND) TO A CURRENT RU MEMBER, CONTINUE WITH LOOP_12
OTHERWISE, GO TO BOX_44C LOOP_12
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK HX48-END_LP12
LOOP DEFINITION: LOOP_12 COLLECTS PRIVATE HEALTH INSURANCE INFORMATION. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS: - ESTABLISHMENT IS PROVIDER OF PRIVATE HEALTH INSURANCE TO A CURRENT RU MEMBER AND - THE INSURANCE COVERAGE PROVIDED BY THE ESTABLISHMENT IS CREATED DURING THE CURRENT ROUND HX48
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
DISPLAY ‘{do/does}’ IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED ‘1’ (YES, COVERED NOW) FOR THE POLICYHOLDER, AND THE CURRENT ROUND IS NOT ROUND 5. OTHERWISE, DISPLAY ‘did’. DISPLAY ‘as of {END DATE}’ IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
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 HX48OV
OTHERWISE, GO TO BOX_33 HX48OV
SPECIFY: BOX_33
IF ESTABLISHMENT TYPE IS NOT INSURANCE CO. OR HMO AND HX48 IS CODED ‘5’ (MEDICARE SUPPLEMENT OR MEDIGAP) ONLY OR ‘5’ AND ANY OTHER CODES, CONTINUE WITH HX49
IF ESTABLISHMENT TYPE IS INSURANCE CO. OR HMO AND HX48 IS CODED ‘5’ (MEDICARE SUPPLEMENT OR MEDIGAP) ONLY OR ‘5’ AND ANY OTHER CODES, AUTOMATICALLY CODE HX49 WITH APPROPRIATE RESPONSES BY CAPI AND THEN GO TO BOX_35
OTHERWISE (I.E., HX48 IS NOT CODED ‘5’ (MEDICARE SUPPLEMENT OR MEDIGAP)), GO TO BOX_35 HX49
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
FLAG INSURANCE CO./HMO AS ‘SUPPLYING MEDICARE SUPPLEMENT/MEDIGAP BENEFITS’. ALSO FLAG AS CURRENT ROUND’S INSURER(S) FOR THIS ESTABLISHMENT- PERSON-PAIR.
BOTH INSURER NAME AND INSURER TYPE MUST BE ENTERED.
CONTINUE WITH BOX_35 BOX_35
IF ESTABLISHMENT TYPE IS INSURANCE COMPANY, INSURANCE COMPANY - FROM AGENT, OR HMO, AND HX48 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) (BUT NOT ‘5’ (MEDIGAP)), FLAG INSURANCE COMPANY/HMO AS ‘SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS’ AND AUTOMATICALLY CODE HX51 WITH APPROPRIATE RESPONSES BY CAPI AND GO TO BOX_40
IF ESTABLISHMENT TYPE IS NOT INSURANCE COMPANY, INSURANCE COMPANY - FROM AGENT, OR HMO, AND HX48 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) AND NOT ALSO CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), CONTINUE WITH HX51
IF ROUND 1 AND HX48 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) AND ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP) (IN COMBINATION WITH ANY OTHER CODES), GO TO BOX_40
IF HX48 IS NOT CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT IS CODED ‘2’ (DENTAL), ‘3’ (PRESCRIPTION DRUGS), ‘4’ (VISION), ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), ‘6’ (LONG TERM CARE IN A NURSING HOME), ‘7’ (EXTRA CASH FOR HOSPITAL STAYS), ‘8’ (SERIOUS DISEASE OR DREAD DISEASE), OR ‘91’ (OTHER), GO TO BOX_40
IF HX48 IS CODED ANY COMBINATION OF ONLY CODES ‘9’ (DISABILITY), ‘10’ (WORKER’S COMPENSATION) OR ‘11’ (ACCIDENT), GO TO END_LP12
IF ROUND 1 AND HX48 IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW), GO TO BOX_40
IF ROUND 2, 3, 4, OR 5 AND HX48 IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW), GO TO BOX_40 HX51
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
FLAG INSURANCE CO./HMO AS ‘SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS’. ALSO FLAG AS CURRENT ROUND’S INSURER(S) FOR THIS ESTABLISHMENT-PERSON-PAIR.
BOTH INSURER NAME AND INSURER TYPE MUST BE ENTERED.
CONTINUE WITH BOX_40 BOX_40
IF THIS ESTABLISHMENT-PERSON-PAIR HAS AT LEAST ONE INSURER THAT PROVIDES HOSPITAL AND PHYSICIAN BENEFITS OR THAT PROVIDES MEDICARE SUPPLEMENT/ MEDIGAP COVERAGE AND THE POLICYHOLDER IS NOT LISTED AS A COVERED PERSON WITH MEDICAID OR GOVT- HOSPITAL/PHYSICIAN FOR THE CURRENT ROUND, CONTINUE WITH LOOP_17
OTHERWISE, GO TO BOX_41A LOOP_17
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON- INSURER-TRIPLES-ROSTER, ASK BOX_40A - END_LP17
LOOP DEFINITION: LOOP_17 COLLECTS INFORMATION ON PLANS THAT PROVIDE HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP COVERAGE TO EACH POLICYHOLDER NOT ALSO COVERED BY MEDICAID OR GOVT- HOSPITAL/PHYSICIAN TO DETERMINE IF THAT PLAN IS AN HMO/MANAGED CARE PLAN. THIS LOOP CYCLES ON TRIPLES THAT MEET THE FOLLOWING CONDITIONS: - ESTABLISHMENT IS PROVIDER OF HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP COVERAGE AND - PERSON IS NOT LISTED AS A COVERED PERSON WITH MEDICAID OR GOVT-HOSPITAL/PHYSICIAN AND - INSURER IS THE SOURCE OF THE HOSPITAL AND PHYSICIAN BENEFITS PROVIDED TO PERSON THROUGH THE ESTABLISHMENT (I.E., THE INSURANCE COMPANY OR SELF-INSURED COMPANY) BOX_40A
IF INSURER IS AN HMO (EPIN.INSTYPE = 2), GO TO END_LP17
OTHERWISE (I.E., IF INSURER IS NOT AN HMO), CONTINUE WITH BOX_41 BOX_41
PRESENT MANAGED CARE (MC) SECTION FOR THIS INSURER
AT COMPLETION OF THE MC SECTION, CONTINUE WITH END_LP17 END_LP17
CYCLE ON NEXT TRIPLE ON RU-ESTABLISHMENT-PERSON- INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE TRIPLES MEET THE STATED CONDITIONS, END LOOP_17 AND CONTINUE WITH BOX_41A BOX_41A
IF HP04A IS CODED ‘1’ (YES, PLAN IS EXCHANGE) OR IF THIS ESTABLISHMENT-PERSON-PAIR IS FLAGGED AS ‘EXCHANGE COVERAGE’ (HX03=11 OR HX23=14) AND IS FLAGGED AS ‘SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS’ (HX48 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT NOT ‘5’ (MEDIGAP)) AND POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH HX60A
OTHERWISE, GO TO BOX_42 HX60A
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX51 FOR ‘{INSURER RECORDED AT HX51}’ IF A PLAN NAME WAS ENTERED. OTHERWISE, USE A NULL DISPLAY BOX_42
IF ROUND 1 OR ROUND 3 AND IF HX48 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP), CONTINUE WITH HX60
OTHERWISE, GO TO BOX_43 HX60
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
HARD CHECK: MEDICARE SUPPLEMENTAL OR MEDIGAP PLANS: MEDICARE SUPPLEMENTAL OR MEDIGAP PLAN LETTER MUST BE 1 CHARACTER LONG, A-L, UPPER OR LOWER CASE. IF CODED OTHER THAN A-L DISPLAY THE FOLLOWING MESSAGE: “Medicare Supplemental or Medigap Plan letter must be A through L. Verify and re-enter plan letter.” BOX_43
IF ROUND 1 OR ROUND 3, GO TO HX61
OTHERWISE (I.E., IF ROUNDS 2, 4, OR 5), CONTINUE WITH BOX_43A BOX_43A
IF THIS ESTABLISHMENT-PERSON-PAIR: - IS FLAGGED AS ‘GROUP’ (HX03=1 OR 2 OR HX23=1) OR ‘INSURANCE COMPANY-FROM AN AGENT’ (HX03=5 OR HX23=4) OR ‘INSURANCE COMPANY’ (HX03=6 OR HX23=5) OR ‘HMO’ (HX03=7 OR HX23=6) OR ‘EXCHANGE COVERAGE’ (HX03=11 OR HX23=14) OR ‘UNKNOWN TYPE -COLLECTED AT OTHER’ (HX03=91 OR HX23=91) AND - IS FLAGGED AS ‘SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS’ (HX48 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT NOT ‘5’ (MEDIGAP)) AND - POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH HX61
OTHERWISE, GO TO END_LP12 HX61
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY. BOX_43B
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX62
OTHERWISE, GO TO HX62A HX62
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
DISPLAY ‘{do/does}’ IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED ‘1’ (YES, COVERED NOW)) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY ‘did’.
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY. HX62OV1
{Is/Was} that per year, per month, per week, or what?
DISPLAY ‘Is’ IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED ‘1’ (YES, COVERED NOW)) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY ‘Was’. HX62OV2
SPECIFY: BOX_44
IF THIS ESTABLISHMENT-PERSON-PAIR: - IS FLAGGED AS ‘GROUP’ (HX03=1 OR 2 OR HX23=1) OR ‘INSURANCE COMPANY-FROM AN AGENT’ (HX03=5 OR HX23=4) OR ‘INSURANCE COMPANY’ (HX03=6 OR HX23=5) OR ‘HMO’ (HX03=7 OR HX23=6) OR ‘EXCHANGE COVERAGE’ (HX03=11 OR HX23=14) OR ‘UNKNOWN TYPE -COLLECTED AT OTHER’ (HX03=91 OR HX23=91) AND - IS FLAGGED AS ‘SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS’ (HX48 IS CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT NOT ‘5’ (MEDIGAP)) AND - POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH HX62A
OTHERWISE, GO TO BOX_44A HX62A
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF BOX_44A
IF ROUND 1 OR ROUND 3, CONTINUE WITH BOX_44B
OTHERWISE, GO TO END_LP12 BOX_44B
IF INSURANCE BEING ASKED ABOUT PROVIDES MEDICARE SUPPLEMENT/MEDIGAP COVERAGE (I.E., HX48 IS CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES), GO TO END_LP12
OTHERWISE, CONTINUE WITH HX63A HX63A
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF
DISPLAY ‘$1,300 or $1,300’ IN THE QUESTION TEXT AND ‘$1,300’ IN THE RESPONSE CATEGORY OPTIONS IF THE POLICYHOLDER IS THE ONLY COVERED RU MEMBER AND THERE ARE NO DEPENDENTS OUTSIDE THE RU (HP17 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)) FOR THE PAIR BEING ASKED ABOUT. OTHERWISE (E.G., AT LEAST ONE RU MEMBER, OTHER THAN THE POLICYHOLDER IS LISTED AS A COVERED PERSON FOR THIS PAIR OR HP17 IS CODED ‘1’ (YES) FOR THIS PAIR OR THE POLICYHOLDER IS NOT IN THE RU), DISPLAY ‘family’ and ‘$2,600 or $2,600’ IN THE QUESTION TEXT AND ‘$2,600’ IN THE RESPONSE CATEGORY OPTIONS. IF POLICYHOLDER IS FLAGGED AS ‘DECEASED’ AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER <= 2 AND HP17 IS CODED ‘2’ (NO), ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW), THEN DISPLAY ‘1,300 or 1,300’ IN THE QUESTION TEXT AND ‘1,300’ IN THE RESPONSE CATEGORY OPTIONS. IF POLICYHOLDER IS FLAGGED AS ‘DECEASED’ AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER <= 2 AND HP17 IS CODED ‘1’ (YES), THEN DISPLAY ‘family’ AND ‘2,600 or 2,600’ IN THE QUESTION TEXT AND ‘2,600’ IN THE RESPONSE CATEGORY OPTIONS. IF POLICYHOLDER IS FLAGGED AS ‘DECEASED’ AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER > 2, THEN DISPLAY ‘family’ AND ‘2,600 or 2,600’ IN THE QUESTION TEXT AND ‘2,600’ IN THE RESPONSE CATEGORY OPTIONS. HX63B
{POLICYHOLDER FIRST MIDDLE LAST NAME} {NAME OF END_LP12
CYCLE ON NEXT PAIR IN RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_12 AND CONTINUE WITH BOX_44C BOX_44C
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX63C
OTHERWISE, GO TO BOX_45 HX63C
{STR-DT} HX63D
{STR-DT}
ROSTER DETAILS: TITLE: RU_MEMBERS_1 COL # 1 HEADER: NAME 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: DISPLAY ALL PERSONS AGE 16 OR OLDER. HX63E
{STR-DT}
DISPLAY ‘{do/does} {you/{PERSON}}’ AND ‘this FSA’ IF ONLY ONE RU MEMBER SELECTED AT HX63D. OTHERWISE, DISPLAY ‘does your family’ AND ‘these FSAs all together’.
SOFT CHECK: RANGE CHECK: $1-$5000 BOX_45
IF ROUND 1, CONTINUE WITH BOX_46
OTHERWISE, GO TO BOX_50 BOX_46
IF ALL PERSONS IN RU HAVE HEALTH INSURANCE (I.E., FLAGGED AS HAVING MEDICARE, MEDICAID/SCHIP, GOVT-HOSPITAL/PHYSICIAN, TRICARE/CHAMPVA, OTHER PUBLIC OR PRIVATE INSURANCE) COVERAGE ON JANUARY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, GO TO BOX_48
OTHERWISE, (AT LEAST ONE RU MEMBER BORN BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, IS WITHOUT HEALTH INSURANCE ON JANUARY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL), CONTINUE WITH LOOP_18 LOOP_18
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX64-END_LP18
LOOP DEFINITION: LOOP_18 COLLECTS INFORMATION ABOUT RU MEMBERS WITH NO HEALTH INSURANCE ON JANUARY 1, {YEAR}, WHERE YEAR IS THE FIRST CALENDAR YEAR OF THE PANEL. THIS LOOP CYCLES ON RU MEMBERS WHO ARE NOT A COVERED PERSON IN ANY ESTABLISHMENT-POLICYHOLDER-COVERED-PERSON-TRIPLE THAT MEETS THE FOLLOWING CONDITIONS: - ESTABLISHMENT IS MEDICARE, MEDICAID/SCHIP, GOVT- HOSPITAL/PHYSICIAN, OTHER PUBLIC, TRICARE/CHAMPVA, OR PRIVATE INSURANCE AND - PERSON IS A CURRENT RU MEMBER WITH A BIRTH DATE PRIOR TO DECEMBER 31, {YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL (OR AGE CATEGORY > 1) AND - PERIOD OF COVERAGE INCLUDES JANUARY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL. HX64
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): IN THE QUESTION TEXT, “... on JANUARY 1, {YEAR},” ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL. IN THE QUESTION TEXT, “... at any time in the years {YEAR} or {YEAR}?” CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. (FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE ‘2005 or 2006?’). HX65
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL FOR “‘YEAR’ OR ‘YEAR’?”. (FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE ‘2005 or 2006?’).
‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS. HX66
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
IF HX65 IS NOT CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY THE DATE ENTERED AT HX65 FOR ‘MONTH AND YEAR FROM HX65’. DISPLAY ‘{YEAR} or {YEAR}’ IF HX65 IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW), WHERE ‘YEAR’ AND ‘YEAR’ DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE ‘2005’ or ‘2006’.
FOR ‘STATE PROGRAM N’, DISPLAY AN ACTUAL NAME OF A STATE PLAN. FOR THE SPECIFIC NAMES OF PLANS BY STATE, SEE ATTACHMENT 36.
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 OTHER CODES, CONTINUE WITH HX66OV
OTHERWISE, GO TO END_LP18 HX66OV
SPECIFY: END_LP18
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_18 AND CONTINUE WITH BOX_48 BOX_48
IF NO CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, {YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE ANY TYPE OF COMPREHENSIVE PUBLIC INSURANCE (I.E., MEDICARE, MEDICAID/SCHIP, GOVT- HOSPITAL/PHYSICIAN, OR TRICARE/CHAMPVA) AND NO CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, {YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE ANY PRIVATE INSURANCE THAT INCLUDED HOSPITAL AND PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/ MEDIGAP BENEFITS ON 1/1/{YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, GO TO BOX_49
OTHERWISE, CONTINUE WITH LOOP_19 LOOP_19
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX70-END_LP19
LOOP DEFINITION: LOOP_19 COLLECTS INFORMATION ON ALL RU MEMBERS WITH PUBLIC AND PRIVATE HEALTH INSURANCE PROVIDING HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP BENEFITS ON JANUARY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, TO DETERMINE PERIODS OF COVERAGE IN {YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. THIS LOOP CYCLES ON PERSONS THAT MEET THE FOLLOWING CONDITIONS: - PERSON IS A CURRENT RU MEMBER AND - PERSON’S DATE OF BIRTH IS BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, OR PERSON’S AGE IS AGE CATEGORIES 2-9 AND - PERSON HAD COMPREHENSIVE HEALTH INSURANCE COVERAGE ON 1/1/{YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL. COMPREHENSIVE HEALTH INSURANCE REFERS TO THE PERSON BEING A COVERED PERSON ON AT LEAST ONE OF THE FOLLOWING ESTABLISHMENT-POLICYHOLDER-COVERED-PERSON- TRIPLES ON 1/1/{YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL: - ESTABLISHMENT IS MEDICARE - ESTABLISHMENT IS MEDICAID/SCHIP - ESTABLISHMENT IS TRICARE - ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN - ESTABLISHMENT IS PRIVATE WITH HOSPITAL AND PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP (I.E., HX48 = 1 OR 5) HX70
{POLICYHOLDER FIRST MIDDLE LAST NAME} {STR-DT}
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR ‘YEAR’ IN, “... on JANUARY 1, {YEAR},” DISPLAY THE FIRST CALENDAR YEAR OF THE PANEL. FOR ‘YEAR’ IN “... at any time in {YEAR},” DISPLAY THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. HX71
{POLICYHOLDER FIRST MIDDLE LAST NAME} {STR-DT}
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR ‘YEAR’ IN THE QUESTION TEXT, DISPLAY THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. HX71OV
ENTER UNIT: END_LP19
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_19 AND CONTINUE WITH BOX_49 BOX_49
IF ALL CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, {YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE ONLY PRIVATE INSURANCE THAT INCLUDES HOSPITAL AND PHYSICIAN BENEFITS AND/OR ALL CURRENT RU MEMBERS HAVE ONLY COMPREHENSIVE PUBLIC INSURANCE ON JANUARY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, GO TO BOX_50
OTHERWISE, CONTINUE WITH LOOP_20 LOOP_20
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX76-END_LP20
LOOP DEFINITION: LOOP_20 COLLECTS INFORMATION FOR EACH RU MEMBER WHOSE DATE OF BIRTH IS PRIOR TO 12/31/{YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, (OR AGE CATEGORY > 1), AND WHO IS COVERED BY PRIVATE INSURANCE THAT DOES NOT INCLUDE EITHER HOSPITAL/ PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP BENEFITS ON JANUARY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL. THE LOOP CYCLES ON PERSONS WERE EVER COVERED BY A MORE COMPREHENSIVE PLAN THAT PROVIDED HOSPITAL/ PHYSICIAN COVERAGE DURING {YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, OR {YEAR}, WHERE ‘YEAR’ IS TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. THE LOOP CYCLES ON PERSONS THAT MEET THE FOLLOWING CONDITIONS: - PERSON IS A CURRENT RU MEMBER AND - PERSON’S DATE OF BIRTH IS BEFORE 12/31/{YEAR}, WHERE ‘YEAR’ IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, OR IN AGE CATEGORIES 2-9 AND - PERSON DID NOT HAVE COMPREHENSIVE HEALTH INSURANCE COVERAGE ON 1/1/{YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL. COMPREHENSIVE HEALTH INSURANCE REFERS TO THE PERSON BEING A COVERED PERSON ON AT LEAST ONE OF THE FOLLOWING ESTABLISHMENT-POLICYHOLDER- COVERED-PERSON-TRIPLES ON 1/1/{YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL: - ESTABLISHMENT IS MEDICARE - ESTABLISHMENT IS MEDICAID - ESTABLISHMENT IS TRICARE - ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN - ESTABLISHMENT IS PRIVATE WITH HOSPITAL AND PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP (I.E., HX48 = 1 OR 5) AND - PERSON IS COVERED PERSON ON AT LEAST ONE OF THE FOLLOWING ESTABLISHMENT-POLICYHOLDER-COVERED- PERSON-TRIPLES ON 1/1/{YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL:
- ESTABLISHMENT IS GROUP 1 OR GROUP 2 OTHER PUBLIC - ESTABLISHMENT IS PRIVATE WITHOUT HOSPITAL AND PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP (I.E., HX48 IS NOT CODED 1 OR 5) HX76
{PERSON’S FIRST MIDDLE AND LAST NAME}
DISPLAY ‘had health...(BELOW)’ IF PERSON CONFIRMED AS POLICYHOLDER (HP09 IS CODED ‘1’ (YES)) OR SELECTED AS POLICYHOLDER (SELECTED AT HP11) OR SELECTED AS A DEPENDENT (SELECTED AT HP16) FOR ANY PRIVATE ESTABLISHMENT-POLICYHOLDER PAIR WHERE HX48 IS NOT CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS) AND NOT CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES FOR ALL OF THOSE PRIVATE ESTABLISHMENT-POLICYHOLDER PARIS. OTHERWISE, USE A NULL DISPLAY. DISPLAY ‘was....program’ IF PERSON SELECTED AT HX19 (FOR EITHER GROUP 1 OR GROUP 2 PROGRAM). OTHERWISE, USE A NULL DISPLAY. DISPLAY ‘and’ IF PERSON CONFIRMED AS POLICYHOLDER (HP09 IS CODED ‘1’ (YES)) OR SELECTED AS POLICYHOLDER (SELECTED AT HP11) OR SELECTED AS A DEPENDENT (SELECTED AT HP16) FOR ANY PRIVATE ESTABLISHMENT-POLICYHOLDER PAIR WHERE HX48 IS NOT CODED ‘1’ (HOSPITAL AND PHYSICIAN BENEFITS) AND NOT CODED ‘5’ (MEDICARE SUPPLEMENT/MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES FOR ALL OF THOSE PRIVATE ESTABLISHMENT-POLICYHOLDER PAIRS AND PERSON SELECTED AT HX19 (FOR EITHER GROUP 1 OR GROUP 2 PROGRAM).
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): IN THE QUESTION TEXT, “... on JANUARY 1, {YEAR},” ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL. IN THE QUESTION TEXT, “... at any time in the years {YEAR} or {YEAR}?” CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. (FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE ‘2005 or 2006?’). HX77
{PERSON’S FIRST MIDDLE AND LAST NAME}
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL FOR “‘YEAR’ OR ‘YEAR’?”. (FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE ‘2005 or 2006?’).
‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS. HX78
{PERSON’S FIRST MIDDLE AND LAST NAME}
IF HX77 IS NOT CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW), DISPLAY THE DATE ENTERED AT HX77 FOR ‘MONTH AND YEAR FROM HX77’. DISPLAY ‘in {YEAR} or {YEAR}’ IF HX77 IS CODED ‘-7’ (REFUSED) OR ‘-8’ (DON’T KNOW), WHERE “‘YEAR’ or ‘YEAR’” DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE ‘2005’ or ‘2006’.
FOR ‘STATE PROGRAM N’, DISPLAY AN ACTUAL NAME OF 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 36.
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 OTHER CODES, CONTINUE WITH HX78OV
OTHERWISE, GO TO END_LP20 HX78OV
SPECIFY: END_LP20
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_20 AND CONTINUE WITH BOX_50 BOX_50
IF ROUND 2 OR ROUND 4, CONTINUE WITH HX81
OTHERWISE, GO TO BOX_51 HX81 When answering the next questions, think about money
that your HX82
Does anyone in your family currently have any medical
bills that
IF HX81 IS CODED ‘2’ (NO), GO TO BOX_51
OTHERWISE, CONTINUE WITH HX83 HX83
Does anyone in your family currently have any medical
bills that BOX_51
GO TO NEXT QUESTIONNAIRE SECTION
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