Examining Substitution: State Strategies to Limit "Crowd Out" in the Era of Children's Health Insurance Expansions. A. Interviews of selected state children's health program, Medicaid, and MCH directors were conducted in order to obtain specific program information.


The Lewin Group completed in-depth interviews of children's health insurance program directors, Medicaid directors, Maternal and Child Health directors, and related individuals in nine states selected for this study. The nine states were chosen for their experience with children's health programs as well as for geographic diversity. These interviews provided background information on state programs, including state experiences with substitution and states' future issues and concerns. Information collected through the interview process has been organized in a database created for the purpose of collecting children's health insurance program, administrative, and legislative information. In addition, eight states, including representatives of the study states and several others who either seriously considered the issues surrounding substitution or had implemented mechanisms to limit substitution, were invited to participate in a roundtable discussion which also included researchers and selected federal staff.