The Child Health Insurance Program: Early Implemenation in Six States. Chapter VI: Chip in Ohio


History and Implementation
Ohio’s Medicaid program for children, called Healthy Start, is administered by the Ohio Department of Human Services (ODHS). When Title XXI was enacted, the state agency already had the necessary statutory and spending authority to expand Healthy Start.

After Congress passed Title XXI, Ohio submitted two amendments to its Medicaid State Plan as well as a CHIP Plan. Using Title XXI to cover uninsured children and Title XIX1 to provide wraparound services for under-insured children, Ohio developed a more comprehensive health insurance system. Since the State Legislature had already given ODHS statutory authority to expand Medicaid, there was little legislative debate on CHIP’s first phase. (See Figure 1).

Figure 1: Children Ineligible for
for CHIP2 Pass through for a Title XIX Eligibility Determination

Figure 1: Children Ineligible for for CHIP Pass through for a Title XIX Eligibility Determination

When children who are under 150 percent FPL apply for health insurance, ODHS checks to determine if they have had access to private health coverage. All children who meet program eligibility and get coverage through Healthy Start are tracked and coded differently depending on their insurance status:

  • Children who have no coverage qualify for CHIP and the state receives a 70 percent match from Title XXI.
  • Children who now have or had access to private insurance qualify for Healthy Start and the state receives a 60 percent match from Medicaid.
  • By using a Combined Programs Application (CPA), the distinction between CHIP and Healthy Start is invisible to families. The benefits packages are the same and so are the providers. Medicaid contracts with licensed private sector managed care plans in all major urban areas of the state. Consequently, many Healthy Start children receive their care through a private health insurance plan and even have the same membership cards.

Ohio is implementing its CHIP program in phases:

  • Phase I: Healthy Start/CHIP covers children ages 0-18 up to 150 percent FPL. See Exhibit 1: Ohio Medicaid expansion. Prior to the expansion, Ohio’s Healthy Start covered children ages 0-5 up to 133 percent FPL; and ages 6-14 up to 100 percent FPL. There was no Healthy Start for children ages 15-19. That age group could only get coverage if they were in a family that received cash assistance or if they were eligible by virtue of a disability.
  • Ohio is a highly industrialized and unionized state in which many families with incomes under 150 percent FPL have access to employer-provided health care coverage. Since a child does not have to be uninsured to be eligible for Healthy Start, (an insured child would be covered under Medicaid), underinsured children can enroll. The number of underinsured people in Ohio is likely to be high because of the existence of coverage in low wage jobs. The availability of wrap around insurance for a limited benefit package can be very helpful to many families.
  • Phase II: The Governor created a Task Force in January 1998 to study how to expand CHIP to 200 percent FPL. The Task Force had 17 members representing health care providers, consumer advocates, businesses, state representatives, public health agencies and private health care plans. They met ten times from February-June 1998 and then submitted recommendations to the Governor.

Insert Figure 2 Here
  • The Task Force’s recommendations included: an expansion of program eligibility to 200 percent FPL; minimal cost-sharing expenses for families; and a 90-day enrollment waiting period. It was also recommended that ODHS administer Phase II to utilize existing Healthy Start and CHIP administrative structures and service delivery arrangements. Final decisions about expansion will be debated as part of the legislature’s biennial budget for state fiscal years 2000 and 2001.
  • State officials estimate that 40,000 children will be eligible for the Healthy Start/Phase II, but believe that only 50 percent of that population will actually enroll.
  • In addition to sharing providers, it is likely that the benefit package offered to Phase II enrollees will closely resemble the Healthy Start benefits. However, families who enroll their children in the expanded Phase II will likely pay co-payments for the same services that children under 150 percent FPL will receive free. The amounts of co-payments, as well as other details, remain undetermined.
  • ODHS officials already had contracts with managed care plans to serve families and children covered by Medicaid. When the Healthy Start expansion group was added, ODHS’ contracted actuary, Deloitte and Touche helped ODHS revisit the rates to reflect the new population.

Children's Health Insurance Task Force

Federal/State Financing

  • Ohio’s Title XXI allocation of Federal funds in the first year was $115 million.
  • The state match rate is 29 percent.
  • The state share will be $8.8 million.

Current Enrollment

  • Between January and December 1998, 85,257 children were enrolled for the Healthy Start expansion and CHIP program. By June 1999, the maximum number of children enrolled is expected to be 133,000. Approximately 67 percent of eligible children in December 1998 entered the CHIP program (i.e., they previously had no health insurance).
  • To date, 13 private plans participate in Healthy Start and CHIP. Among Ohio’s 88 counties, 16 are covered by managed care and nearly 60 percent of the current Healthy Start population are located in those counties. Each provider is required to submit utilization, encounter and quality assurance data to the state.

Key Factors for Ohio’s Implementation

  • The Medicaid expansion sped implementation. Because Ohio chose to do a Medicaid expansion, they were able to use existing administrative structures and service delivery arrangements to minimize administrative costs of CHIP and combine outreach efforts.
  • Timing was helpful. When Title XXI was enacted, the Department of Human Services already had legislative authority to expand Medicaid so they were able to establish the first phase of the program quickly and efficiently.
  • Applications by phone accelerated enrollments. Ohio offers a toll-free consumer hotline with evening and weekend hours to make it easy for families to get information about Healthy Start and CHIP and apply by phone.
  • Welfare reform fund facilitated county outreach. Ohio allocated most of its enhanced Federal matching funds available under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) to counties in order to generate community-specific outreach. PRWORA funds target those at risk of loosing or not gaining Medicaid coverage, which includes children potentially eligible for Healthy Start.
  • Mail-in applications helped parents. Ohio uses a simplified two-page Healthy Start application that can be mailed in so parents do not have to apply at a government office.


State Approach
Ohio combines state and community-level outreach strategies. The 88 counties in the state have the opportunity to develop customized outreach plans while state-level efforts are also underway.

Key Players and Administration

  • Ohio Department of Human Services (ODHS)
  • Local community efforts involving advocates, county commissioners, departments of health, and providers.

Ohio Department of Human Services

  • Families and service providers can call a Consumer Hotline (1-800-324-8680) to receive information about Healthy Start that includes brochures, posters, and cards with the hotline number on them. The hotline operators facilitate enrollment by completing applications and mailing them to applicants for signatures. Applicants sign the form, attach the necessary documentation, and return the application by mail to ODHS.
  • ODHS is working with many state agencies to disseminate information about Healthy Start. State agencies that have requested information about Healthy Start from ODHS include: Department of Mental Health; Department of Education; Bureau of Employment Services; Child Support Enforcement Agencies; Department of Alcohol & Drug Addiction Services; Department of Health; and the Ohio Minority Commission.
  • The Department is also reaching out to non-profit organizations. Some of the organizations that have received information from ODHS include: Planned Parenthood and Family Planning Agencies; Head Start Association; North American Indian Cultural Centers; Salvation Army; and Urban Appalachian Council.
  • ODHS received a grant from HCFA(now known as CMS) to purchase television time to run paid Healthy Start advertisements.
  • In the first nine months of the Healthy Start expansion, ODHS partnered with a variety of statewide and local agencies to provide information about the expansion and to encourage families to call the hotline.
  • ODHS markets Healthy Start, directly, and encourages consumers to use the statewide consumer hotline as a resource for information and application assistance. Within this work, ODHS is sensitive to the fact that local outreach plans have also created marketing strategies and support structures for applicants. Attempts are made to have complimentary activities and messages—but duplication is sometimes inevitable.
  • The Ohio Child Health Coalition recommended that the state organize both media and school-based campaigns to complement the counties’ efforts to help ensure more consistency. The Coalition is comprised of the following organizations: Association of Ohio’s Children’s Hospitals; Children’s Defense Fund-Ohio; Franciscan Health Partnership Program; Ohio Primary Care Association; Ohio Public Health Association; and the Universal Health Care Action Network of Ohio.
  • ODHS state-level activities include conducting large mailings to targeted populations; overseeing community-level outreach efforts; conducting tailor-made presentations; providing information to interested groups, and participating in local level health fairs and community events.
  • The ODHS is looking into enhancing the current Medicaid Web site to include outreach information.

County Outreach

In order to obtain Federal funds for county-level outreach, counties were required to submit outreach plans to the state for approval.

  • In FY 1998, 61 county plans were submitted and approved. An additional 11 counties submitted plans for FY 1999.
  • The Department reviewed the plans to ensure that they reflect local needs, but allowed communities to develop their own customized Healthy Start outreach strategies.
  • The lead agency for outreach varies among counties (e.g., local Department of Health, county departments of human services, advocacy organizations or organizations contracted to provide outreach).
  • Some local outreach efforts include:
    • Many counties have hotline numbers where people can request an application for Healthy Start. Some counties have coordinated with each other to share responsibility to operate the hotline numbers.
    • Some counties have contracted with non-profit organizations, providers, or health organizations to conduct outreach by providing application assistance, collecting applications, running information lines/hotlines, providing follow-up assistance to get needed verifications, and developing grassroots campaigns.
    • Given the amount of local control, some communities have selected different program names, logos and informational telephone numbers. Advocates and some state staff believe it can be confusing for families who hear about different local health insurance programs that may all be Healthy Start. To address these concerns, some advocates have suggested that the state develop certain basic guidelines to ensure uniformity among communities for the program name, logo, and information telephone numbers.

Collaboration with Other Agencies
Ohio Family and Children First Council

  • The OFCF Council is a Governor’s initiative to create local councils of child and family-serving agencies to coordinate activities for families and children. ODHS partnered with the Council to disseminate information about the Healthy Start expansion.

Department of Health

  • WIC clinics’ staff members received information about the Medicaid expansion and CHIP. ODHS sent a direct mailing to 85,000 WIC households inviting them to call the Consumer Hotline and/or apply for Healthy Start or CHIP. Using its database, the Department targeted families that would probably be eligible. It was estimated that the mailing reached 100,000 children and the Consumer Hotline reported a tremendous response to it.

Bureau for Children with Medical Handicaps

  • The Bureau for Children with Medical Handicaps (BCMH), the state agency serving children with special health care needs, is requiring its families who are at or below 185 percent FPL to apply for Healthy Start. A one-time informational mailing was sent to approximately 5,000 current BCMH families who were directed to call the Consumer Hotline. BCMH is now sending information about Healthy Start to families who are enrolling or being re-certified for BCMH enrollment.

Child Care Centers

  • ODHS sent a mailing to nearly 12,000 licensed home-based and center-based childcare facilities to inform both families and child care providers who may not have health insurance for their children.

Provider Associations

  • ODHS attended over 20 medical association meetings to provide information about the expansion. Many statewide providers published articles about the expansion in their association newsletters, including: Medical Association; Hospital Association; Dental Association; Ambulance Association; and Association of Medical Equipment Suppliers. Presentations were also made to the State Medical Care Advisory Board.
  • The School Nurse Association invited ODHS to participate in four regional conferences to share information and materials. These presentations prompted many requests to the hotline for written materials to use in schools.

Ohio Churches

  • Working with the Commission on Minority Health, ODHS notified many minority clergy about the Healthy Start expansion.
  • ODHS sent a mailing to approximately 13,000 individuals affiliated with the Ohio Council of Churches.

Creating a Seamless Health Care System for Eligible Children

Presumptive Eligibility
Ohio offers presumptive eligibility only for newborns born to women already covered by Healthy Start. Ohio does have retroactive coverage for people eligible in the previous three months, but it does not begin until eligibility has been established.

Continuing Eligibility
Ohio has a six month re-determination cycle. However, significant changes in family income or household composition that occur must be reported, and may therefore affect eligibility.

Simplified Application and Eligibility Decisions

  • Ohio uses a Combined Programs Application (CPA) to enroll children for Healthy Start, WIC, BCMH, and Children and Family Health Services (CFHS). The CPA, created in 1989, was revised in 1991 to be more "user-friendly". The next revision is expected in the summer of 1999. The application will be two pages long and will be available in Spanish and English.
  • Ohio does not require a face-to-face interview for eligibility determination for Healthy Start. The application can be mailed to the county department of human services for processing.

Funding for Outreach

  • Prior to Title XXI, Ohio had decided to access Federal matching funds for Medicaid eligibility outreach under the Temporary Assistance for Needy Families (TANF) block grant of the Personal Responsibility and Work Opportunity Reconciliation Act. The state made almost all of the $16.1 million available to counties based on the number of their potentially eligible Medicaid recipients. Approximately $20 million of combined Federal and local funding is available for FY 1998 activities and comparable funding is available for FY 1999.
  • To receive the funds, county commissioners had to develop an outreach plan through a collaborative process with all the community stakeholders, ensuring that the plans reflect the wishes of the community. Counties were also required to provide the necessary matching funds. In some counties, the match was raised through a collaborative public-private arrangement.

Advice for Other States

  • Build evaluation into outreach activities. Any evaluations should be based both on outcomes (caseload impact) and other measures (e.g., public perception).
  • Create a statewide name and logo for the program even if counties or municipalities are primarily responsible for conducting outreach.
  • Encourage and fund local outreach efforts that complement the statewide strategy but are tailored to the specific community.

Crowd-out Prevention

State’s Response

  • Crowd-out is not an issue for CHIP/Phase I because children with access to health insurance that meet the income requirements are still eligible for the expansion via Title XIX.
  • Crowd-out is expected to be an issue during Phase II. The primary strategy recommended by the Task Force is to impose a 90-day waiting period. In its report, the Task Force wrote: "This period is designed to discourage a family from dropping their existing child coverage in favor of the CHIP Phase II plan, by ensuring that the family will be exposed to a period of financial risk before the coverage would begin."
  • Other recommended strategies to address the problem are:
    • impose some cost sharing for the CHIP plan through an annual non-refundable premium and targeted co-payments;
    • develop measures and mechanisms to monitor crowd-out; and
    • use an Advisory Board as a forum to monitor crowd-out.
  • The State Legislature may debate these and other Task Force recommendations of Phase II during the development of the SFY 2000/2001 biennial budget.

Employer Buy-In
Ohio has no provision for an employer buy-in program at this time.

Data Collection and Evaluation

Data for Program Design

  • ODHS and the Ohio Department of Health (DOH) wanted to assess the impact of expanding Medicaid even before Title XXI. As part of the planning for the Title XIX expansion, ODHS contracted with a private consulting firm (The Lewin Group) to study the number of potentially eligible individuals. Using CPS data, an estimation model was created to convert the uninsured rate into a monthly number that was used to estimate the number of potentially eligible individuals under 150 percent FPL. The study estimated that 290,000 children were potentially eligible, but researchers believed that only 133,000 would actually enroll. State officials used these figures to budget for and plan the Title XIX expansion.
  • During planning for the SFY 98/99 biennial budget, ODHS and Lewin conducted a series of public forums for input about Medicaid program priorities. Forum participants identified expanding Medicaid coverage for children as one of their highest priorities.
  • Additional forums were conducted in the fall of 1997 to receive input from interested parties about the option of covering children up to 200 percent FPL through CHIP. The Task Force considered comments from these forums when they developed recommendations for the expansion.

Data for Program Evaluation

  • ODHS uses data from its Medicaid Management Information System (MMIS) and Client Registration Information System (CRIS-E) to monitor characteristics of its Medicaid population. ODHS data staff use MMIS claims data to analyze utilization and to monitor performance measures. They use CRIS-E to analyze demographics and caseload trends.
  • Healthy Start and other programs are evaluated through the efforts of the Office of Medicaid Health Care Quality Program that assesses quality against standardized quality measures. Examples of activities include: medical record review; consumer satisfaction surveys; feedback to health plans and providers regarding their performance; feedback to consumers in the form of consumer guides; and communication to the public about important findings. Questions are now being added to various instruments to collect data specific to the Healthy Start expansion.
  • For its quality measurement work, ODHS faces certain challenges including how to obtain clinical records from providers; how to improve encounter data submitted by managed care plans; and how to stay current with state-of-the-art quality measurements for medical care.
  • Ohio is now evaluating its outreach efforts funded through PRWORA Medicaid outreach by determining what was actually done for outreach and comparing it to what was planned. They are also looking at best practices, evaluation results, and comparing outreach activities and spending to caseload trends.

Other Data Collection Methods

Ohio Family Health Survey

  • The State Legislature created the Ohio Health Data Center in 1993 to collect, analyze and disseminate health care information. A critical component of the Data Center’s mission is the Ohio Family Health Survey that will provide baseline measures for health status, health coverage, satisfaction with coverage, utilization of services, and access to care. The survey will help assess existing health care trends, monitor impacts of changes in the health care marketplace, and evaluate the impact of health care reforms to provide information to the State Legislature for their health policy decisions. The first survey was fielded in January-August 1998. The Data Center plan to repeat the survey in 2001.
  • The Health Survey will also collect information about the uninsured and underinsured to better understand why families lack insurance. State officials believe that national surveys do not sample enough Ohioans to provide the information that they need.
  • The survey instrument was developed by a committee with representatives from different state agencies (DOH, Medicaid and Mental Health) and the Ohio State University. Survey questions were developed using a variety of sources including SF12, Physical and Mental Health Summary Scales, the National Health Interview Survey, the Current Population Survey, and the Behavioral Risk Factor Surveillance System. Detailed information about the survey and a list of information collected in the survey is included in Appendix 1.
  • The sample size was 16,261 households, where one randomly selected adult was interviewed in each home. If children were members of the selected adult’s family, then an adult family member was asked questions about a randomly selected child. The income levels for the survey sample were determined by poverty level. Among the children interviewed, there were 703 living with families reporting income at 150-200 percent FPL. Of the 5,788 children surveyed 648 were reported as receiving Medicaid.
    • Among the issues related to CHIP that the survey addresses are:
    • Where is a person employed compared to how do they receive insurance coverage?
    • How do Medicaid recipients compare to non-Medicaid recipients in their ability to access health care and insurance?
    • How long have individuals had health insurance?
    • When were individuals last uninsured?
    • Why did families who may be eligible for Medicaid not apply for Medicaid?
    • If a non-Medicaid family below 200 percent FPL applies for Medicaid, what happens to their application?
  • The survey measures access to health care and insurance. It asks individuals with insurance about their satisfaction with the ability to choose a doctor, benefits, ability to get emergency care, out of pocket costs, and the ability to see a specialist. Non-Medicaid recipients with other coverage were asked whether their plans included mental health services, dental care, vision services, hearing services, or prescriptions. They also were asked how much they pay for coverage. Workers were asked whether their employer offered insurance. All respondents were asked about their health care utilization, usual source of care, quality of the services they received, and unmet health care needs. Uninsured respondents were asked why they were uninsured and what kinds of problems they had as a result of being uninsured.
  • Certain geographical area and subgroups were over-sampled to obtain sufficient data for point estimates. Oversampled areas and subgroups were: Appalachian counties (5 counties); rural farm regions (5 counties); metropolitan areas (9 counties); African Americans; Hispanics; Asian/Pacific Islanders; suburban commuters (3 counties).
  • DOH’s initial sample was 12,400 households, but other state agencies and counties were invited to purchase additional surveys. Cuyahoga County, for example, paid to add an extra 1,000 households in its county to the sample. Some counties used their TANF dollars to augment the number of households in their counties’ sample. To encourage counties to purchase additional household surveys, DOH offered to generate county sampling frames and is providing the results in cross-tabulations. The data will be made available to counties that want to conduct additional analysis.
  • The 20-minute telephone survey was conducted in two phases. During Phase 1 (January-May 1998), a few questions were inadvertently skipped for some respondents, so surveyors attempted to re-contact those participants between June and August. This second phase also included additional interviews to meet minimum sample size requirements for African-Americans in several counties, along with newly purchased surveys for five counties. Participants who wanted more information about the survey were encouraged to call the DOH 1-800 number.
  • DOH was the primary contractor for the survey. They issued a RFP and the Gallup Organization won the bid to conduct the survey. The cost of the survey is hard to calculate since there were several contributors. The state contribution from ODH and the ODHS was approximately $800,000, not including ODH and ODHS staff time spent on the project or the costs borne by the six county organizations that purchased additional surveys.
  • A methodology report and a clean database were due to the Data Center by the end of 1998. The first analytical report will present a series of tables by various categories such as insurance status by gender, race, and income. Subsequent reports are expected to include uninsured rates by county and a profile of the number of Medicaid eligible children insured by Medicaid, insured by other plans and uninsured.
  • DOH plans to repeat the survey in three years to see how health care has changed and want to provide the data to universities and other interested researchers to encourage further research.

Web Sites for More Information
For additional information visit their web site:
Appendix 1

Ohio Family Health Survey
Health Services Research and Quality Unit, Health Care Date Center, Office of Policy and Planning, Ohio Department of Health

The General Assembly created the Ohio Health Care Data Center (Data Center) in House Bill 478. It was signed into law in January 1993. The Data Center exists to collect, analyze, and disseminate health care information. This survey is a critical component to the Data Center’s mission. The Data Center has requirements to determine the number of uninsured and underinsured persons in Ohio at the state and county level. It also has other mandates that require good health care information. The survey should provide this required baseline and descriptive information.

Additional impetus for this survey is the Administration’s needs for good information by which to make health care policy decision. In the past several years the pace of marketplace health care reforms has quickened. Moreover, discussions in Washington suggest that significant changes will occur in the administration of public health care programs, as well as the passage of some incremental health care reforms. Finally, the state is also looking at reworking how it administers public health care programs and regulates the private health care system.

These changes will produce intended and unintended consequences. However, without good baseline information, policy makers will be without an effective way to determine these changes. They will be unable to evaluate claims that individuals or groups raise about continuing needs, problems, or solutions. Therefore, the survey serves the purpose of providing Ohio with needed baseline data for monitoring the health care system.

Finally, Ohio’s Medicaid system is facing potentially significant changes. The Medicaid program needs good information about how its population and its system compare to others. This survey will provide the first comprehensive set of data to allow for such a comparison.

Purpose of the Survey
Development of baseline measures of health status, health coverage satisfaction with coverage, utilization of services, and access to care to allow for assessing existing health care trends, monitoring of the impacts of changes in the health care marketplace, and evaluating the impact of health care reforms.

Analysis on specific questions about Ohio’s uninsured population such as the estimated number of uninsured person in Ohio and by country, the reasons for being uninsured, the health status of the uninsured, the health care utilization of uninsured person, the existing costs of serving the uninsured, and the estimated level of unmet need;

Refinement and validation of estimates regarding the number of uninsured and underinsured persons in Ohio at the State and county level from state or national-level data and development of a mechanism for regular updates of this information.

Comparisons of the health status, access to care, utilization of service, and unmet health need patterns between the Medicaid, uninsured, and the commercially insured populations in Ohio;

Assessment of differences in these measures: health status, health coverage, unmet need, satisfaction with coverage, and with different health status levels;

Assessment of the relationship between behavioral risk factors and health care utilization, health care costs, and general health;

Measurement of the extent of movement and reason for a change in coverage source to another in the past year, whether from one employer-based plan to another, from uninsured to insured or vice versa, from Medicaid to insured or uninsured or vice versa.

Sources of Survey Questions
Many of the questions used on the survey were obtained from recognized sources. For example we are using the SF21 (Physical and Mental Health Summary Scales), modified National Health Interview Survey questions for utilization, Census questions for insurance status and demographics including industry and size of employer, and questions from the Behavioral Risk Factor Surveillance System, for lifestyle factors.

Information that will be collected with the questions (* information only collected for adults)

Insurance Coverage

  1. Type and source of current insurance coverage
  2. Medicaid
    Military or Veterans
  3. Previous type and source of insurance coverage if change in status during past 12 months
  4. Insurance coverage of specific benefits
  5. Medications
    Dental care
    Vision services
    Hearing services
    Mental health services
  6. Cost of insurance premium (employer/union based or self-insured)
  7. Number of weeks covered in past 12 months
  8. Change in type of insurance coverage in past 12 months
  9. Reasons for lack of insurance in past 12 months
  10. For currently uninsured last time had coverage
  11. Medicaid past or present, length of coverage

Satisfaction with health care coverage

  1. Ability to choose doctor
  2. Benefits covered
  3. Ability to get emergency medical care
  4. How much they have to pay for medical services

Utilization of health care services and satisfaction with used services

  1. Physician visits
  2. Emergency room visits
  3. Outpatient surgery
  4. Hospital admissions
  5. Dental visits
  6. Pap test*
  7. Mammogram*
  8. Physical exam or well baby check-up (children only)

Access to care

  1. Usual source of care
  2. Ability to see a specialist

Health status

  1. Overall health status
  2. Functional status*
  3. Mental health status*
  4. Chronic conditions
  5. Activities of daily living (ADL) for 65 and over*

Personnel behaviors

  1. Cigarette smoking (current, former, never)*
  2. Physical activity*
  3. Height and weight

Unmet health care needs

  1. While uninsured
  2. Major medical costs
    Delayed or avoided getting care
    Had problems getting care they needed
  3. Listing of problems getting health care such as medical, mental, or dental care. Respondent ask to include medications, equipment and supplies

Financial Burden

  1. How much family had to pay for medical care in past year (out of pocket costs)


  1. Age
  2. Race
  3. Gender
  4. Hispanic Origin
  5. Employment (Industry, Class or worker, Size of employer, Hours work per week)*
  6. Family size
  7. Family income
  8. Martial status*
  9. County of Residence
  10. County of work (for policy holder)*
  11. Zip code
  12. Educational attainment*

Sample Size
The sample size is 12,400 households. One randomly selected adult will be interviewed from each household. If there are children residing in the household who are members of the selected adult’s family a child will be randomly selected. Information will be collected for 12,400 adults and approximately 4,100 children.

Over Sampling
Certain geographical areas and subgroups of the population will be over sampled to provide sufficient sample size for point estimates to be reasonably accurate. The areas and the subgroups are as follows:

Appalachian Region (5 counties)
(Adams, Belmont, Clermont, Jackson, Morgan)
Rural Farm Region (5 counties)
(Ashtabula, Dark, Huron, Logan, Putnam)
Inner City Areas
(Census tracks where proportion of population below the poverty level is 20% or greater)
Industrial Regions
(Proportion of persons 16 years and over employed in manufacturing industries is 30% or greater)
Metropolitan Areas (9 counties)
(Butler, Cuyahoga, Franklin, Lorain, Lucas, Hamilton, Montgomery, Summit, Stark)
African Americans
Asian/Pacific Islanders
Suburban Commuters (3 counties)
(Clark, Delaware, Lake)
Medicaid recipients
Uninsured persons

Who is conducting the Survey?
The Gallup Organization of Princeton, New Jersey obtained the contract to conduct the survey through an RFP using State Purchasing.

Who else is participating?
The Department of Human Services, Medicaid Policy Section (Lorin Ranbom) participated in the development of the RFP, selection of The Gallup Organization, development of the survey instrument, and is paying for part of the survey.

A Health Economist for the Ohio State University, in the School of Public Health (Gil Nestel) has assisted in the development of the survey and analysis of the results.

For additional information contact:
Dave Dorsky (614) 728-4738
Mary Plummer (614) 728-9579


1 - Title XIX is pre-CHIP Medicaid.
2 - Children with insurance