CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings. APPENDIX B: Enrollment Extraction Forms

12/01/2012

Appendix Table B.1. New [MEDICAID/CHIP] Enrollees by Month [Simplified/Traditional Enrollment Procedures]

  (START
12 Months Pre-Simplified Enrollment Procedure)
Month 1
Month 2 (Simplified Enrollment Procedure Implementation)
Month 13
Month 14 Month 15 Month 16+ (as needed) (END)
Dec-11
Number of New Enrollees              
By Subgroup Demographic Characteristics              
Age of Child at Start of Month              
Younger than 1              
1-5              
6-12              
13-18              
19-21              
Unknown              
Race/Ethnicity              
Hispanic              
Non-Hispanic American Indian and Non-Hispanic              
Alaska Native              
Non-Hispanic Asian, Non-Hispanic Native              
Hawaiian and Other Pacific Islander              
Non-Hispanic Black              
Non-Hispanic White              
Other              
Unknown              
Gender              
Female              
Male              
Unknown/ Other              
Primary Language              
English              
Spanish              
Other non-English              
Unknown              
U.S. Citizenship              
Citizen              
Qualified noncitizen              
Nonqualified noncitizen              
Awaiting confirmation              
Other              
Unknown              
Household Income by FPL              
< 100%              
100-< 133%              
133-< 185%              
185-< 200%              
200- < 300%              
300% +              
Unknown              
Residence              
Urban              
Rural              
Unknown              
Family Size              
2              
3              
4              
5              
6 or more              
Unknown              
Number of Children in Household              
1              
2              
3              
4 or more              
Unknown              
END              
Number with Parent/Caregiver Employment              
Private Insurance Coverage
Number with third-party coverage              
 
Number with coverage available from employer (if available)              
Number with recent loss of private coverage (if available)              
Prior Public Coverage              
Number with a previous spell of public coverage, past 3 months              
Number with a previous spell of public coverage, past 6 months              
Number with a previous spell of public coverage, past 12 months              

ELE = Express Lane Eligibility; FPL = Federal poverty level; TANF = Temporary Assistance for Needy Families.


Appendix Table B.2. New [MEDICAID/CHIP] Enrollees Retention Measures [Simplified/Traditional Enrollment Procedures]

  (START 12 Months Pre-Simplified Enrollment Procedure) Month 1 Month 2 (Month When Simplified Enrollment Procedure Is First Implemented) Month 13 Month 14 Month 24+ (as needed) (End) Dec 11
Number of New Enrollees            
Likelihood of Retention            
Number still enrolled 6 months from enrollment            
Number still enrolled 12 months from enrollment            
Number still enrolled 13 months from enrollment            
Number still enrolled 18 months from enrollment            
Number still enrolled 24 months from enrollment            
Disenrollment/Reenrollment Measures            
Number disenrolled (within 6 months)            
Number disenrolled (within 12 months)            
Number disenrolled (within 13 months)            
Number disenrolled (within 18 months)            
Number disenrolled (within 24 months)            
Number disenrolled within 13 months that reenrolled within 3 months            
Number disenrolled within 13 months that reenrolled within 6 months            
Number disenrolled within 13 months that reenrolled within 12 months            
Number disenrolled within 13 months that reenrolled within 3 months via simplified enrollment procedure            
Number disenrolled within 13 months that reenrolled within 6 months via simplified enrollment procedure            
Number disenrolled within 13 months that reenrolled within 12 months via simplified enrollment procedure            
Transfers            
Number of enrollees that transferred to [CHIP/Medicaid] within 6 months            
Number of enrollees that transferred to [CHIP/Medicaid] within 12 months            
Number of enrollees that transferred to [CHIP/Medicaid] within 13 months            
Number of enrollees that transferred to [CHIP/Medicaid] within 18 months            
Number of enrollees that transferred to [CHIP/Medicaid] within 24 months            
Number of enrollees that transferred to [CHIP/ Medicaid] within 6 months via simplified enrollment procedure            
Number of enrollees that transferred to [CHIP/ Medicaid] within 12 months via simplified enrollment procedure            
Number of enrollees that transferred to [CHIP/ Medicaid] within 13 months via simplified enrollment procedure            
Number of enrollees that transferred to [CHIP/ Medicaid] within 18 months via simplified enrollment procedure            
Number of enrollees that transferred to [CHIP/ Medicaid] within 24 months via simplified enrollment procedure            

CHIP = Children’s Health Insurance Program.

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