Medicaid version 56.2The Urban Institute TRIM3 Reference Contact Us Version History
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Medicaid version 56.2 The Urban Institute TRIM3 Reference Contact Us Version History |
Medicaid provides health insurance to low-income individuals. The groups primarily served are the elderly, the disabled, and families with children, although other adults may also be covered. States may extend additional coverage to children and adults via SCHIP.
TRIM3's Medicaid/SCHIP module simulates eligibility for Medicaid and State Children's Health Insurance Programs (SCHIP), identifies which eligible individuals are actually enrolled in the program, and assigns the insurance value of Medicaid eligibility. Eligibility is simulated on a monthly basis -- each person is checked for eligibility in each month of the simulation year. A person might be found eligible for Medicaid or SCHIP in some months of the year but not the entire year. The eligibility rules are simulated in great detail, including the variations in eligibility rules across states. The module is able to simulate both the rules that were in effect prior to the passage of the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA) and the rules in place after PRWORA, including the post-PRWORA "Section 1931" eligibility rules. Like all TRIM3 modules, the Medicaid and SCHIP module can also simulate hypothetical Medicaid and SCHIP rules.
There are some features of the Medicaid and SCHIP programs that TRIM3 does not model. TRIM3 does not simulate eligibility for the institutionalized since they are not in the CPS universe. Further, children under age 15 generally cannot be simulated as eligible by disability, since they do not report their income and labor force information necessary to identify disability. However, the SSI module uses a special imputation process to identify certain children under 15 as receiving SSI. Only these children can be simulated by Medicaid as eligible by disability. The module does not simulate transitional Medicaid benefits for those families no longer receiving cash Temporary Assistance to Needy Families (TANF) benefits due to increased income, increased employment, time limits, or other reasons.
This document describes the operation of the Medicaid and SCHIP module in detail. Note that the discussion refers to the many different "program rules" that control the operation of each TRIM3 Medicaid/SCHIP simulation. Details on each program rule and its potential values can be obtained from the TRIM3 Data Dictionary. The discussion is organized as follows:
For Medicaid, the concept of a filing unit is not as useful as it is in the other tax and transfer programs. Although the family (subfamilies separate) comes closest to providing a useful concept of a filing unit, at many points in the simulation such a definition breaks down and it becomes more useful to define the unit as a married couple or as just an individual. Consequently, in this discussion of TRIM3's simulation of medicaid, we generally refer to the eligibility of a person, rather than of a unit, while at the same time pointing out those places where the eligibility of the person is affected by other people in the household.
Medicaid provides numerous possible paths to eligibility. The various eligibility paths can be grouped into 4 broad categories -- Mandatory, Optional, SCHIP, and Medically Needy. This document handles each of these categories separately, and presents a detailed description of each of the eligibility paths in each of the categories. When appropriate, a path is described using the standard concepts of categorical, asset, and income eligibility. However, many paths are best described by not strictly following this convention -- for example, paths that are largely based upon a person's eligibility for SSI or TANF/AFDC .
Note that in TRIM's terminology, an "eligible" person is someone who has passed all eligibility tests in a particular path, regardless of whether he/she actually enrolls to receive those benefits. In some administrative data, "eligible" means someone who not only passes eligibility tests, but took the further step of obtaining a Medicaid card (although they may not have actually used the card to obtain benefits). In TRIM3's terminology, this is a person who is "enrolled".
The eligibility paths are described below in the order in which they are applied (although the rule HierarchyOption can be used to modify the order). In each month, the first eligibility path that makes a person eligible becomes that person's eligibility type for that month, and no further eligibility testing is performed for that month. A person's monthly eligibility type is stored in the result variable EligibilityType. It is possible for a person to be eligible through different paths in different months of the year, and different members of the same family may be eligible under different paths.
A person's annual eligibility type is stored in AnnualEligibilityType. Persons are categorized as eligible on an annual basis using an "ever-on" concept - if an individual is eligible for at least one month, s/he is considered to be eligible on an annual basis as well. If the type of eligibility varies from month to month, the monthly types are grouped into the following hierarchy of categories, and the type in the highest level (i.e. lowest number) is assigned as the annual type:
If a tie, the type from the earliest of the tied months is chosen -- although for ties among mandatory types, months where the person received TANF/AFDC or SSI benefits are chosen over other mandatory months
Before a non-citizen can be considered for any of the medicaid eligibility paths, he/she must meet medicaid's non-citizen eligibility requirements. Medicaid follows the same procedure for determining non-citizen eligibility as other TRIM3 simulation modules (click here for details). The only modification Medicaid makes to this method is that the national-level rule TempAlienEligible is replaced by the state-level rule StateTempAlienEligible.
When the Medicaid module needs to measure assets, one of three methods is used:
When the Medicaid module needs to measure income, one of three methods is used:
Before the passage of PRWORA, all recipients of TANF/AFDC were automatically eligible for Medicaid. Information about the amount of TANF/AFDC benefits a person is simulated to receive is passed to the Medicaid module via the program rule AFDCBenefitsReceived. Any person simulated to receive benefits (AFDCBenefitsReceived > 0) is considered eligible for Medicaid.
The rule AfdcAutoElig allows the user to disable this eligibility path. This path should be disabled when simulating post-PRWORA rules.
Receipt of federally funded SSI benefits (as opposed to supplemental state benefits) automatically makes an individual eligible for Medicaid. Unlike TANF/AFDC receipt, this rule was maintained after PRWORA. Information about SSI benefits received is passed from the SSI simulation via the program rules SSIBenefitsReceived and SSIFederalBenefitsEligFor. Any person simulated to receive benefits (SSIBenefitsReceived > 0) and some or all of those benefits were federal benefits (SSIFederalBenefitsEligFor > 0) is considered eligible for Medicaid. Information regarding the type of SSI unit the person belongs to (and hence which of the medicaid eligibility types -- 3 thru 6 -- to assign to the person) is passed from the SSI simulation via the rule SSIUnitType.
For a few states, the asset and income tests applied in this path are actually more strict than those applied in the baseline SSI simulation. States that have expanded their SSI eligibility rules since 1972 are permitted to deny Medicaid eligibility to SSI recipients who would not have been eligible under their state's more restrictive 1972 rules. This restriction is referred to as "Rule 209B", and is the only case in which a federally funded SSI recipient is denied Medicaid eligibility in TRIM3. The rules beginning with Rule209B... are used to indicate which states have the 209b rule in effect, as well as the levels of those more restrictive income and asset limits. Rule209BIncomeLimitSize1 and Rule209BAssetLimitSize1 give the 209b asset and income limits for one-person SSI units, and Rule209BIncomeLimitSize2 and Rule209BAssetLimitSize2 give that information for two-person SSI units. The measures of income and assets calculated by the SSI module are used when determining if the 209b requirements are met. These amounts are passed from the SSI simulation via the rules SSISimulatedAvailableIncome and SSISimulatedUnitAssets.
The program rule SSICashOption gives the user the option of disabling this eligibility path.
The 1996 PRWORA act added a section "1931" to the Social Security Act, which made it mandatory for states to provide Medicaid coverage to low-income families who meet the pre-PRWORA AFDC income and resource standards and other requirements that were in effect on July 16, 1996. TRIM3 simulates this mandatory aspect of Section 1931 eligibility by performing a special run of the TANF/AFDC module that simulates each state's 1996 AFDC eligibility requirements , including complex rules for income disregards (excluding certain types of income such as child care or work expenses when determining eligibility), asset testing (including the value of certain assets when determining eligibility), and categorical eligibility requirements. The results of this special run are accessed by the Medicaid module via the program rule Mandatory1931Eligible. Anyone simulated to be eligible for TANF/AFDC in the special run (i.e. Mandatory1931Eligible > 0) is considered eligible for medicaid. Note that only TANF/AFDC eligibility, not participation, is required in this special run.
The rule Other1931Eligible can be used to specify alternative methods for achieving 1931 eligibility.
Note: For the 1997 and 1998 baseline simulations of medicaid, 1931 eligibility was simulated in a simplified form (click here for details).
Before the passage of PRWORA, persons who pass all of their state's TANF/AFDC eligibility requirements but who are only eligible for an amount of benefits below the program's minimum benefit requirement, were automatically eligible for Medicaid. Information on whether the TANF/AFDC eligibility tests are passed is given to the Medicaid module via the following rules:
The federal government mandates that certain persons be covered by Medicaid if their family's income is below a specified percent of poverty. To be eligible through this path, individuals must pass the following tests:
State optional eligibles are persons who states may cover under guidelines established by the federal government. Some of the eligibility paths in this category are similiar to the mandatory pathways, while some are unique to this category.
As discussed in the section on "Mandatory" eligibility, Section 1931 of the Social Security Act requires that a state cover persons who meet the 1996 AFDC requirements for eligibility. However, states can diverge from the AFDC plans in effect on July 16, 1996 as follows:
The rule Other1931Eligible can be used to specify alternative methods for achieving 1931 eligibility.
Note: For the 1997 and 1998 baseline simulations of medicaid, 1931 eligibility was simulated in a simplified form (click here for details).
As described in the "Mandatory" section, persons who are receiving federal SSI benefits must be covered by a state's Medicaid program. States may extend Medicaid eligibility to persons who, while not receiving federal SSI benefits, are receiving state supplements. The program rule DoesSSIStateSupQualifyForMcaid indicates for each state whether or not it offers this extension. Information about a person's receipt of state supplements is passed from the SSI simulation via the program rules SSIBenefitsReceived and SSIFederalBenefitsEligFor. A person for whom SSIBenefitsReceived > 0 but SSIFederalBenefitsEligFor = 0 is receiving only state supplements. Information regarding the type of SSI unit the person belongs to (and hence which of the medicaid eligibility types -- 7 thru 10 -- to assign to the person) is passed from the SSI simulation via the rule SSIUnitType.
As is the case with mandatory SSI eligibility, optional eligibility is denied to persons who fail to meet their state's "Rule 209b" restrictions (if any).
Before PRWORA, states had the option to extend Medicaid eligibility to individuals eligible for TANF/AFDC benefits but not receiving any. In TRIM3, the rule DoesAFDCEligQualifyForMedicaid is used to indicate which states extend Medicaid eligibility to eligible non-recipients. Information on whether the TANF/AFDC eligibility tests are passed is given to the Medicaid module from the TANF/AFDC module via the following rules:
States may also extend Medicaid eligibility to persons who, while not receiving any SSI benefits (neither federal nor state), are eligible for either federal benefits or state supplements. The program rule DoesSSIEligQualifyForMedicaid indicates for each state whether or not it offers this extensions. Information about a person's eligibility for federal or state SSI is passed from the SSI simulation via the program rules SsiBenefitsEligibleFor and SSIFederalBenefitsEligFor. Information regarding the type of SSI unit the person belongs to (and hence which of the medicaid eligibility types -- 12 thru 19 -- to assign to the person) is passed from the SSI simulation via the rule SSIUnitType.
As is the case with other SSI-related eligibility, optional eligibility is denied to persons who fail to meet their state's "Rule 209b" restrictions (if any).
Under AFDC (and continuing under TANF) states had the option of not providing benefits (or not providing full benefits) to families with two non-disabled parents in which the primary wage-earner was unemployed (also called "UP" units). If the state does not choose to include these families in their TANF/AFDC program, they still have the option to extend Medicaid eligibility to these families, via the rule DoesUPEligInNonUPQualForMcaid. In TRIM3, families with an unemployed head in such a state are eligible if they pass their state's TANF/AFDC income and asset tests but fail to meet the state's definition of a single or incapacitated-parent (IP) unit. Information on whether the TANF/AFDC asset and income eligibility tests are passed from the TANF/AFDC module via the following rules:
States may extend "percent-of-poverty" eligibility by increasing the age, income, and/or asset limits beyond the minimum mandatory federal limits. These higher limits can be specified through the following rules:
States may also extend percent-of-poverty eligibility to elderly or disabled individuals. Such persons will be eligible if their income is below the percent-of-poverty specified by the rules PovBasedStatePctForDisabled and PovBasedStatePctForElderly, as long as they pass the SSI asset test. The amount of a person's income is based on the measure used for determining SSI eligibility, and is passed from the SSI simulation via the rule SSISimulatedAvailableIncome, while information as to whether they passed the SSI asset test is passed via the rule SSIPassAssetTest.
A special category of optional Medicaid eligibility for children is the "Ribicoff" category. Under this category, states can extend Medicaid eligibility to children under a certain age who pass the state's TANF/AFDC asset and income tests but are not eligible for benefits because they are in neither a single-parent family nor in a two-parent family qualifying as IP or UP (i.e. the child fails the "parent" test).
The age cutoff for Ribicoff eligibility in each state is specified by the rule RibicoffChildrenStateAge. Information on whether a child passes the TANF/AFDC asset and income tests are passed via the following rules:
Note that after the passage of PRWORA in 1996, the TANF/AFDC tests that the child must pass are based on 1996 AFDC rules, not the current year's rules. Thus, for post-PRWORA runs the above information should come from the mandatory 1931 run of the TANF module (which simulates eligibility based on 1996 AFDC rules), rather than from a current-year run.
Depending upon the setting of CHIPOption, persons who are covered by other types of insurance may not be eligible for SCHIP:
| Medicaid Extension Programs | Separate State Programs | |||
|---|---|---|---|---|
| Minimum Age | Maximum Age | Minimum Age | Maximum Age | |
| Age Range # 1 | McdExtLowAge1 | McdExtHighAge1 | CHIPLowAge1 | CHIPHighAge1 |
| Age Range # 2 | McdExtLowAge2 | McdExtHighAge2 | CHIPLowAge2 | CHIPHighAge2 |
| Medicaid Extension Programs | Separate State Programs | |||
|---|---|---|---|---|
| Free | Premium | Free | Premium | |
| Age Range # 1 | McdExtFreePct1 | McdExtPremPct1 | CHIPFreePct1 | CHIPPremPct1 |
| Age Range # 2 | McdExtFreePct2 | McdExtPremPct2 | CHIPFreePct2 | CHIPPremPct2 |
| Method for Determining Disregard/Deduction | Amount to Disregard/Deduct (if applicable) | |
|---|---|---|
| Child Care Expenses | CHIPChildCareDeductOption | CHIPMaxChildCareDeduct |
| Child Support Income | CHIPChildSuppDisregardOption | CHIPMaxChildSuppDisregard |
| Work Related Expenses | CHIPWorkExpDisregardOption | CHIPWorkExpDisregard |
Some states that offer SCHIP coverage for parents treat caretaker relatives (over 18) as if they were parents. The program rule CHIPNumCaretakersEligible indicates for each state whether caretaker relatives are treated the same as parents, and if so, whether both or just one caretaker can be eligible. To be considered a caretaker relative, a person must meet the same criteria as a parent, except that all the children under 18 who are living with them must be "other relatives" rather then "own children". Regardless of whether all, some, or none of the caretakers are eligble, all of their collective income is counted when determining the eligibility of other family members.
States with "Medically Needy" programs cover persons whose income after medical expenses is under a state-specified threshold. This may include persons whose income is above the threshold prior to medical costs, but who "spend down" to below the threshold, as well as persons with very low medical expenses or no medical expenses whose income is low enough to fall below the threshold.
Different regression equations are used to estimate insurance values for different user groups and for different health expenditure categories. The user groups are: children (under 19, and not head/spouse of a family, and not pregnant, and not disabled), adults (not disabled, and 19-64 or under 19 but head/spouse of a family or pregnant), disabled (under 65 and disabled according to the SSI module's definition), and elderly (anyone 65 or older). The expenditure categories are: mandatory Medicaid costs, drug costs, long-term care, home health care, and other costs. (Long-term care and home health care insurance values are estimated only for aged and disabled persons.) The explanatory variables include sex, race, age, number of months eligible for Medicaid during the year, whether living in a rural location, receipt of TANF/AFDC or SSI benefits, whether eligible for Medicaid under the Medically Needy program, whether the head of the family or a dependent (for the groups under age 21 and 21-64). The equations were estimated using actual Medicaid expenditures from HCFA's "tape-to-tape" data system.
After the regression equations have been evaluated for a particular Medicaid eligible, adjustment factors are applied. The factors vary by user group, expenditure type and by state. (They are coded in the state-specific rules beginning AdjAdult..., AdjAged..., AdjChild..., and AdjDisabled.) The adjustment factors serve three purposes: simulating the state-level variation in insurance costs, adjusting for price increases since the year of the data used to estimate the equations, and aligning to targets. Targets are computed by user group, state, and expenditure category. (The targets are coded in the state-specific rules beginning TgtAdult..., TgtAged..., TgtChild..., and TgtDisabled.) Adjustment factors are established for each year during that year's baseline simulation.
During a baseline run, the determination of whether a person enrolls in an eligible month is made outside of the medicaid module. This requires that an extract file be created from a medicaid run in which all eligibility-related rules have been set to their baseline values. A series of SAS programs are then run on this extract, the end result being a file which indicates for each person whether they enroll in each month. This file must be imported into TRIM as a supplemental results file for the year being modelled. Once imported, the VariableList rule BaselineEnrollmentDecision should be set to point to the variable Enroll from this supplemental results file. When the medicaid module needs to determine if a person is enrolled in a given month, it refers to this variable.
Unlike the baseline enrollment decision, the enrollment decision for an alternative run is made within the medicaid module. Consequently, alternative simulations can be run without needing to re-do the baseline enrollment procedure. In an alternative simulation, the monthly enrollment decision for persons who were eligible in that month in the baseline is the same as the baseline decision. Information on the baseline decision is obtained from the same supplemental results file that was used in the baseline run, via the VariableList rule BaselineEnrollmentDecision. For persons who were not eligible in that month in the baseline, a logit equation is used to assign an enrollment probability. However, since the enrollment decision for newly-eligible persons is made jointly for all newly-eligible members of a family (subfamilies separate), these person-level probabilities must be combined into a single family-level probability. The method used to combine them is specified by the rule NewlyEligEnrProb:The resulting family-level probability is compared to a random number to determine if all the newly-eligible members of the family enroll in that month. The coefficients of the logit equation which is used to assign the person-level probabilties of enrollment to newly-eligible persons during an alternative run are as follows:
| Dummy Variable | Coefficient |
|---|---|
| Medicaid child | 0.106965 |
| SCHIP child | -0.4787 |
| Child age 0 | -0.55867 |
| Child age 1-5 | 1.146442 |
| Child age 6-12 | 1.052676 |
| Child with family income <100% pov. | 1.907145 |
| Child with family income 100-200% pov. | 0.492884 |
| Adult Medicaid | 1.063281 |
| Adult SCHIP | 0.317048 |
| Disabled Medicaid | 1.377276 |
| Disabled, medically needy | -0.17506 |
| Disabled, age 19-44 | 0.095804 |
| Elderly Medicaid | -0.34152 |
| Elderly, with family income <100% pov. | 0.31277 |
The resulting probabilties of enrollment are as follows:
| Medicaid Children | <100% pov | 100 - 200% pov | 200%+ pov |
|---|---|---|---|
| Child age 0 | 81% | 51% | 39% |
| Child age 1-5 | 96% | 85% | 78% |
| Child age 6-12 | 96% | 84% | 76% |
| Child age 13+ | 88% | 65% | 53% |
| SCHIP Children | <100% pov | 100 - 200% pov | 200%+ pov |
|---|---|---|---|
| Child age 0 | 70% | 37% | 26% |
| Child age 1-5 | 93% | 76% | 66% |
| Child age 6-12 | 92% | 74% | 64% |
| Child age 13+ | 81% | 50% | 38% |
| Adults | |
|---|---|
| Adult Medicaid | 74% |
| Adult SCHIP | 58% |
| Disabled Medicaid | Medically needy | Not Medically Needy |
|---|---|---|
| Disabled age 19-44 | 79% | 81% |
| Disabled age 45+ | 77% | 80% |
| Elderly Medicaid | |
|---|---|
| <100% poverty | 79% |
| 100%+ poverty | 74% |
In both baseline and alternative runs, after the initial monthly enrollment decisions have been made (as described above), the medicaid module simulates the effect of "continuous enrollment". Continuous enrollment allows a child (defined as age 18 or younger) to remain enrolled in Medicaid or SCHIP for a certain number of months without requiring the parents to report changes in income or other circumstances. Thus, under continuous enrollment rules, a child might be covered by Medicaid or SCHIP in a month when s/he is technically ineligible based on the family's income in that month.
Three state-specific program rules indicate the number of months of continuous coverage offered by a state to children in different categories. RepPeriodKidsMcdExceptMedNeedy gives the months of continuous coverage for children eligible for Medicaid, with the exception of those eligible as medically-needy; RepPeriodKidsSCHIPMcdExtension gives the months of continuous coverage for children eligible under SCHIP-funded Medicaid expansions; and RepPeriodKidsSCHIPSeparate specifies continuous coverage of children under separate-state SCHIP programs. In addition, RepPeriodKidsOption can hold state-specific options that cannot be captured by the standard rules.
If the relevant continuous-coverage rule is set to 1 month, there is no continuous enrollment. However, if it is set to a number greater than 1, continuous coverage is simulated. In that case, once a child in that state/category is initially simulated to enroll in one month, his/her enrollment is automatically extended to the full continuous-coverage period. For example, if the rules indicate 6 months of continuous coverage for non-medically-needy Medicaid children, a child first simulated to enroll in March will be automatically simulated as enrolled through August. Note that a child may not be able to "use" all of his/her months of continuous coverage during the simulation year, if the simulation year ends before the months are used. Since we do not model the opposite case when a child is eligible in January due to a spell of continuous coverage that began in the prior year, the effects of continuous coverage are slightly under-stated.
Note that TRIM3's simulation of continuous enrollment is not affected by the simulated monthly eligibility status during the months of continuous enrollment. Once a child covered by continuous enrollment is simulated to enroll in a particular month, s/he is simulated to enroll for the rest of the continuous enrollment period, even if s/he is technically ineligible in some or all of the remaining months in the period. Further, the simulation of continuous enrollment does not affect the simulated eligibility variables, as currently programmed. Thus, the output variables might indicate that a child is both ineligible and enrolled in a particular month. Or, a child might be simulated as enrolled in Medicaid in a month when s/he is coded as eligible for SCHIP, but not Medicaid. All such discrepancies in the output variables are due to continuous coverage.
The current simulation of continuous enrollment does not currently capture some nuances in the continuous coverage rules. In particular, we do not capture rules specifying that a child's continuous SCHIP enrollment ends if s/he becomes enrolled in ESI and/or if s/he becomes eligible for Medicaid.
To simulate post-PRWORA rules, the rule IncomeCalculationType should be set to 1, and the following rules should be turned off:
The minimum Section 1931 eligibility criteria are modeled using a "Mandatory" Section 1931 simulation run of TANF, which is essentially the same as the 1996 baseline AFDC run. The eligibility results of this run are passed to the Medicaid module via the rule Mandatory1931Eligible. Deviations from the minimum criteria are modeled using an "Optional" Section 1931 simulation run of TANF, which incorporates any expansions and/or deviations from the 1996 AFDC eligibility rules. Results of this run are passed to Medicaid via the rule Optional1931Eligible. The rule Other1931Eligible can be used to override or supplement the 1931 eligibility indicated by the rules Mandatory1931Eligibile and Optional1931Eligible, by specifying special state-level rules for 1931 eligibility.
To simulate the fact that Ribicoff and Medically Needy eligibility are now linked to 1996 AFDC eligibility, the following rules in the AFDC Info category should be changed to point to results from a 1996 TANF/AFDC run (in order to minimize the number of special TANF/AFDC runs required, these rules were set to point to the Mandatory 1931 run, which is essentially the same as a 1996 AFDC baseline):
SSI:
TANF/AFDC :
The input variable HealthMedicaidCoverage is created during the conversion of CPS data to TRIM3 format, and is used by the Medicaid module to determine if a person is a reporter. Starting with the March 2001 CPS, a separate variable is created during the conversion (HealthCHIPCoverage) that indicates reported SCHIP coverage, and is also used by the Medicaid module (via the rule SCHIPReported) to determine if a person is a reporter. For details regarding how these variables are created, see the article Using Health Insurance Coverage Variables. Due to the likelihood that many persons may be confused as to whether they are covered by Medicaid as opposed to SCHIP (or vise-versa), the Medicaid module does not separate reporters into SCHIP-reporters and Medicaid-reporters, but just treats them all as undifferentiated "reporters". Thus, a child eligible for either Medicaid or SCHIP is treated as a "reporter" if s/he is reported to be covered by either Medicaid or SCHIP.
When referenced by the Medicaid module, these variables (HealthMedicaidCoverage and HealthCHIPCoverage) indicate whether Census considers the person to be covered. However, this doesn't necessarily mean that the person actually reported that they were covered, since Census sometimes imputes (or "allocates") a positive response to the coverage questions if the person either didn't answer them or the answer conflicts with other information.
For TRIM3's purposes, such "allocated" persons are not considered covered. Thus, the next step to determining reporter status is to take those persons who are indicated to be covered by HealthMedicaidCoverage or HealthCHIPCoverage and drop out those that had coverage allocated to them. Allocated coverage is indicated via special variables called "allocation flags". The allocation flag AllocFlagMedicaidCoverage applies to the variable HealthCoveredMedicaid, the flag AllocFlagCHIP (specified via the rule SCHIPAllocated) applies to the variable CHIPCoverage, and the allocation flag HealthOtherPlanTypeImputed applies to all the "catch-all" questions.
Therefore, if HealthMedicaidCoverage indicates coverage, but AllocFlagMedicaidCoverage indicates that allocation was done, then the reported medicaid coverage is ignored. Similarly, if HealthCHIPCoverage indicates coverage, but AllocFlagCHIP indicates that allocation was done, then the reported SCHIP coverage is ignored. Note that even if HealthMedicaidCoverage indicates coverage, and AllocFlagMedicaidCoverage indicates that allocation was not done, it is still possible that the reporter status was allocated. If HealthCoveredMedicaid indicates no coverage, then this means the coverage indicated by HealthMedicaidCoverage was obtained from the "catch-all" questions. In this case, if the "catch-all" allocation flag HealthOtherPlanTypeImputed indicates that allocation was done, the reported medicaid coverage is ignored. An additional allocation flag is available -- AllocFlag665 -- which indicates whether the entire record (rather than just the response to a particular question) was allocated. If this flag indicates allocation, then the reporter is also dropped.
Special variables were available before the March 1995 CPS which indicated whether a child (i.e. person < 15) was covered by Medicaid. Consequently, when using 1993 or earlier input data, children are considered reporters if they either pass the above criteria or:
If HealthChildCoveredbyMedic = 1 and AllocFlagMedicChildren not = 1 and AllocFlagMedicNumberOfChildren not = 1.
The annual output variable IsReporter indicates whether a person was considered to be a Medicaid reporter by the TRIM3 simulation, and is calculated for all persons, regardless of their Medicaid eligibility. The monthly variable IsReporterThisMonth indicates (for reporters) which months TRIM3 imputes the reported coverage to apply to. This is done by assigning coverage to a number of the eligibles months equal to the variable HealthMedicaidMonthsCovered. If there are more eligible months than HealthMedicaidMonthsCovered, months are selected by ranking them according to their eligibility category as follows:
In an alternative run, pregnancy can only be simulated using option #2. When this option is chosen, the rule PregnancyIndicator should refer to the monthly result variable IsPregnant produced by the baseline run. Option #2 can also be used in a baseline run if the user wishes to use an outside source of pregnancy information.
When using option #1 before version 56_1 of medicaid, the "ineligible reporter" method of imputation was implemented in a simplified manner. In addition, if option #1 was used in a baseline run, it also needed to be used in any corresponding alternative runs, since the result variable IsPregnant was not set for women imputed to be pregnant by the "ineligible reporter" method.
Once covered by Medicaid, a pregnant woman must be covered throughout her pregnancy. Therefore, if eligibility is simulated during one month of the pregnancy, or the woman is already simulated to be enrolled in Medicaid when she becomes pregnant, the module assumes the woman is eligible in all subsequent months of her pregnancy. The woman is assigned an eligiblity type of 42 (eligible due to pregnancy via the mandatory eligibility path) for all subsequent months of her pregnancy regardless of whether she actually passes this path's eligibility requirements. The only exception is for months where the woman is eligible as types 1,3,4,5,6, or 22. For these months the eligibility type is not changed to 42.