Medicaid version 65.1 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:

• Filing Unit

• Eligibility -- Overview
• Monthly and Annual Eligibility
• Non-Citizen Eligibility
• Assets
• Income
• Unrelated Children
• Eligibility -- Mandatory
  • TANF/AFDC Cash Eligibility
  • SSI Cash Eligibility
  • Section 1931 Mandatory Eligibility
  • TANF/AFDC Near-Cash Eligibility
  • ACA Eligibility
  • Percent of Poverty Eligibility

• Eligibility -- State Optional
  • Section 1931 Optional Eligibility
  • TANF/AFDC Child-only Eligibility
  • SSI Cash Supplements Eligibility
  • TANF/AFDC non-cash Eligibility
  • SSI non-cash Eligibility
  • TANF/AFDC non-UP Eligibility
  • Percent-of-Poverty Eligibility
  • Ribicoff Eligibility
  • 1115 Waiver Eligibility

• Eligibility -- SCHIP
  • SCHIP and Other Coverage
  • Child Eligibility
  • Adult Eligibility

• Eligibility -- Medically Needy

• Benefits

• Enrollment
  • Monthly Enrollment
  • Continuous Enrollment
  • Annual Enrollment

• Additional Information
  • Post-PRWORA rule settings
  • Information from the SSI and TANF/AFDC Modules
  • Setting up an Alternative Simulation
  • Determining Reporter Status
  • Simulating Pregnancy-based Eligibility
  • Kinship Care

Filing Unit

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.

As indicated above, when reference is made to "family", subfamilies (both related and unrelated) are treated as separate families. However, in some states, certain types of adults -- step parents, unmarried parents, and non-parent partners -- are treated differently than others when determining family composition. Begining with the March 2007 CPS (the input data for the 2006 simulation year), TRIM is able to identify these types of adults, and so is able to model the different treatments. The rules in the subcategory Parents determine how such persons are treated, and the result variables in the output category Parents contain some of the results of the processing (details).

Overview of Eligibility Determination

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".

Monthly and Annual Eligibility

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:

1. Mandatory eligibility
2. Optional eligibility
3. SCHIP eligibility
4. Medically Needy

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

Non-Citizen Eligibility

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.

Legal aliens are eligible for Medicaid if they have been in the US for at least the number of years specified in the state-level rule EligIfInUSNumberOfYears and if they pass the sponsor deeming test.

The CHIP Reauthorization Act of 2009 (CHIPRA) gives states the option to allow otherwise eligible legal immigrant children and pregnant women to be covered under Medicaid and optionally CHIP regardless of how long they have been in the country. The state-level rule CHIPRA214 specifies if a state does apply CHIPRA and whether it applies to children (persons under 21), pregnant women, or both. Immigrants eligible via this option are not subject to the sponsor deeming test.

Assets

When the Medicaid module needs to measure assets, one of three methods is used:

1. The asset measure calculated for SSI eligibility is used, which is passed from the SSI simulation via the rule SSISimulatedUnitAssets.
2. The asset measure calculated for TANF/AFDC eligibility is used, which is passed from the TANF/AFDC simulation via the rule AFDCAssetsOfUnit.
3. The mediciad module calculates its own measure of assets. The income amounts specified by the rules FamilyAssetIncome or FamilyAssetIncomeReporters are summed for all members of the family (related subfamilies are treated as separate families). The result of this computation is stored in the monthly result variable MonthlyFamilyAssetIncome. To convert asset income into actual assets, this amount is divided by an assumed rate of return of 6% to come up with an implied value of assets. In addition, any lump-sum income (LumpSumIncomVars) that is to be treated as assets (LumpSumTreatment) is added.

Income

When the Medicaid module needs to measure income, one of three methods is used:

1. The income measure calculated for SSI eligibility is used, which is passed from the SSI simulation via the rule SSISimulatedAvailableIncome.
2. The income measure calculated for TANF/AFDC eligibility is used, which is passed from the TANF/AFDC simulation via the rule AFDCNetIncomeOfUnit.
3. The medicaid module calculates its own measure of income. The income amounts specified by the rules FamilyEarnedIncome, FamilyChildSupportIncome, and FamilyUnearnedIncome are summed for all persons in the family (related subfamilies are treated as separate families). The program rule ApplyIncomeSmoothing can be used to "smooth" monthly fluctuations in earned income (Click here for details). The result of this computation is stored in the monthly result variable FamilyIncome. Particular eligibilty paths may make further adjustments to this amount.

Unrelated Children

Mandatory Eligibility

TANF/AFDC Cash Eligibility (eligibility type 1)

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.

SSI Cash Eligibility (eligibility types 3-6)

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.

Section 1931 Mandatory Eligibility (eligibility type 90)

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).

TANF/AFDC Near-Cash Eligibility (eligibility type 22)

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:

• AFDCPassParentTest
• AFDCPassAssetTest
• AFDCPassGrossIncomeTest
• AFDCPassNetIncomeTest

ACA Eligibility (eligibility type 29)

Under the ACA, starting in 2014 all non-elderly persons below a certain percent of poverty (specified in program rule ACAMandPct) must be covered by Medicaid. The determination of percent-of-poverty for this eligibility pathway is based on the tax unit's modified AGI (MAGI). A unit's percent-of-poverty is calculated on an annual basis by TRIM's FederalTax module and written out as a result variable. The variablelist rule ACAMAGI is used to reference this result variable. The tax unit ids have to be provided in the variablelist rule ACAUnitID.

Percent of Poverty Eligibility (eligibility types 42-45)

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:

• Categorical eligibility: The individual must be either pregnant, an infant (i.e. age = 0), or a young child (i.e. not an infant but under the age limit specified by either the rule PovBasedMandAgeForChildren1 or PovBasedMandAgeForChildren2).

• Asset test: If the person is a pregnant woman or an infant, their family's assets must not exceed the level specified by the program rule PovBasedMandAssetForPregAndInf. If the person is a young child, their family's assets must not exceed the level specified by the program rule PovBasedMandAssetForChildren1 (if they are under the age specified by PovBasedMandAgeForChildren1) or by the program rule PovBasedMandAssetForChildren2 (if they are under the age specified by PovBasedMandAgeForChildren1). The measure of assets used depends upon the setting of the rule IncomeCalculationType, which in turn depends upon whether PRWORA rules are being simulated:
  • Post-PRWORA (IncomeCalculationType = 1): Medicaid's own measure of assets is used.
  • Pre-PRWORA (IncomeCalculationType = 0): The asset measure calculated for TANF/AFDC eligibility is used, which is passed from the TANF/AFDC simulation via the rule AFDCAssetsOfUnit. For persons not members of an TANF/AFDC unit, medicaid's own measure is used.

• Income test: If the person is a pregnant woman, the family's income as a percent of poverty must not exceed the level specified by the program rule PovBasedMandPctForPregnant. If the person is an infant, the level is specified by the program rule PovBasedMandPctForInfants. For young children, the level is specified by either PovBasedMandPctForChildren1 (if under the age specified by PovBasedMandAgeForChildren1) or by PovBasedMandPctForChildren2 (if under the age specified by PovBasedMandAgeForChildren1). The measure of income used depends upon the setting of the rule IncomeCalculationType, which in turn depends upon whether PRWORA rules are being simulated:
  • Post-PRWORA (IncomeCalculationType = 1): Medicaid's own measure of income is modified by adding any income TANF/AFDC considered deemed to the family (AfdcDeemedIncome) and any lump-sum income (LumpSumIncomVars) that is to be treated as income (LumpSumTreatment). Beginning with version 56.5 of the Medicaid module SSI and TANF/AFDC benefits received by the family (SSIBenefitsReceived, AFDCBenefitsReceived) are not treated as income. To include SSI and TANF benefits in income one has to specify Opt #6 in the DebugOptions.
    This new income amount is then reduced by the deductions and disregards specified by several state-specific rules. A fixed amount is disregard from earnings (FamilyEarningsFixedDisregard), a fraction is disregard from the remainder (FamilyEarningsFractDisregard), a fixed amount is disregarded from child support income (FamilyChildSupportDisregard), and a fixed amount of child care expenses is disregarded from the result(FamilyChildCareExpDisregard). Note that in the Medicaid module, these disregards and deductions are applied to the entire year even if in the "real world" the disregards are only applied to part of the year (for example, the first four months).

  • Pre-PRWORA (IncomeCalculationType = 0): The income of the person as determined for TANF/AFDC eligibility is used. This amount is passed from the TANF/AFDC simulation via the rule AFDCNetIncomeOfUnit. For persons not members of an TANF/AFDC unit, medicaid's own measure is used.

State Optional Eligibility

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.

Section 1931 Optional Eligibility (eligibility type 91)

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:

• States have the option to lower their income standards, but not below the AFDC standards in effect as of May 1, 1988.
• States have the option to increase their income or resource standards based on a percentage that does not exceed the percentage increases in the Consumer Price Index that have occurred since July 16, 1996.
• States have the option to use income and resource methodologies that are less restrictive than those used under the AFDC State plan as of July 16, 1996.

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).

TANF/AFDC Child-only Eligibility (eligibility type 81)

SSI Cash Supplements Eligibility (eligibility types 7-10)

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).

TANF/AFDC non-cash Eligibility (eligibility type 11)

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:

• AFDCPassParentTest
• AFDCPassAssetTest
• AFDCPassGrossIncomeTest
• AFDCPassNetIncomeTest

SSI non-cash Eligibility (eligibility types 12-19)

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).

TANF/AFDC non-UP Eligibility (eligibility type 25)

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:

• AFDCPassAssetTest
• AFDCPassGrossIncomeTest
• AFDCPassNetIncomeTest

Percent of Poverty Eligibility (eligibility types 46-49 & 40-41)

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:

• PovBasedStateAgeForChildren1
• PovBasedStateAgeForChildren2
• PovBasedStatePctForChildren1
• PovBasedStatePctForChildren2
• PovBasedStatePctForPregnant
• PovBasedStatePctForInfants
• PovBasedStateAssetForChildren1
• PovBasedStateAssetForChildren2
• PovBasedStateAssetForPrgAndInf

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.

Ribicoff Eligibility (eligibility type 20)

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:

• AFDCPassAssetTest
• AFDCPassGrossIncomeTest
• AFDCPassNetIncomeTest

• RibiPassAssetTest
• RibiPassNetIncome
• RibiPassGrossIncomeTest
• RibiPersonType.

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.

1115 Waiver Eligibility (eligibility type 23)

• Categorical Eigibility: The following rules indicate which demographic groups are categorically eligible:
  • SpecialProgramAdultPct
  • SpecialProgramChildPct
  • SpecialProgramDisabledAdultPct
  • SpecialProgramParentPct
  • SpecialProgramPregnantPct
  • SpecialProgramReporterPct
  • SpecialProgramAnyonePct
  A non-zero value for a state indicates that the state has a program for this group. See the dictionary definition of each rule for a description of the covered group. Note that none of these groups ever include the elderly.

• Asset Test: During pre-PRWORA simulations (IncomeCalculationType = 0) asset tests are not applied. For post-PRWORA simulations the asset levels are specified by the rules SpecialProgramAdultAssetLimit and SpecialProgramParentAssetLimit (other groups do not have asset tests). Assets are measured using medicaid's own method.

• Income Test: The value (non-zero) in each of the "SpecialProgram...Pct" rules specifies the percent-of-poverty cutoff for eligibility. During pre-PRWORA simulations (IncomeCalculationType = 0) medicaid's own measure of income is used (note that this is a simplification, but it is justified given the relatively few states that had 1115 waivers before PRWORA). For post-PRWORA simulations, the same measure of income is used as in the mandatory percent-of-poverty tests. Note that the rule SpecialProgramAFDCElig does not require an income test -- the person simply has to be eligible for TANF/AFDC .

SCHIP Eligibility

SCHIP and Other Coverage

Depending upon the setting of CHIPOption, persons who are covered by other types of insurance may not be eligible for SCHIP:

1. Simulate SCHIP, don't deny coverage due to ESI or other government coverage. Under this setting, other coverage does not affect SCHIP eliigbility.
2. Simulate SCHIP, deny coverage due to ESI or other governmental coverage. Under this setting, persons who are covered by employer sponsored insurance (ESI), Medicare, Champus, or other military health care are ineligible for SCHIP coverage. Information about these types of coverage are accessed as follows:
   • ESI: via the program rule ESICoverage
   • Medicare: via the program rule MedicareEnrollment
   • CHAMPUS and other military health care: by direct reference to the input variable HealthChampusCoverage
   This coverage information is supplied on an annual basis. In order to use it in the determination of monthly SCHIP eligibility, TRIM assumes that a person reported to be covered by Medicare, Champus or other military health care is covered the entire year. This assumption is not appropriate for ESI, so TRIM assumes that a person covered by ESI is covered only in those months when the head or spouse (not children) of the family are working (i.e. have positive earnings), regardless of whose employer supplies the coverage.
3. Simulate SCHIP, deny coverage due to ESI or other governmental coverage. Retiree and COBRA ESI assumed. This setting is the same as the previous setting except for it's determination of monthly ESI coverage. If the head and/or spouse of a family have any earnings during the year, monthly ESI coverage is determined the same as in the previous method (i.e. only those months with earnings are considered ESI-covered months). However, if neither head nor spouse has any earnings during the year, TRIM assumes that the family's ESI coverage comes from a previous employer (i.e. retiree coverage or COBRA), and therefore considers every month to be an ESI-covered month.

SCHIP for Children (eligibility types 70-73)

• Categorical Eligibility: Persons are categorically eligible if they fall into one of two age ranges. All persons in either of the two ranges are categorically eligible, even if the person is the head or spouse of a family. Age ranges do not vary between "free" and "premium" programs, but they do vary between medicaid extension programs and separate state programs. The following table shows which state-specific program rules are used to indicate these age ranges.

  	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

• Asset Test: To be eligible, children must pass an asset test. Just one rule, CHIPAssetLimit is needed to specify the asset limits for the SCHIP children program (although this rule has separate values for Medicaid expansion programs and separate state SCHIP programs). The measure of assets used depends upon the setting of the rule IncomeCalculationType, which in turn depends upon whether PRWORA rules are being simulated:
  • Post-PRWORA (IncomeCalculationType = 1): Medicaid's own measure of assets is used.
  • Pre-PRWORA (IncomeCalculationType = 0): The asset measure calculated for TANF/AFDC eligibility is used, which is passed from the TANF/AFDC simulation via the rule AFDCAssetsOfUnit. For persons not members of an TANF/AFDC unit, medicaid's own measure is used.

• Income Test: The final test for SCHIP eligibility looks at income as a percent of poverty. The following table shows which program rules are used to indicate the percent-of-poverty income threshold.

  	Medicaid Extension Programs		Separate State Programs
  	Free	Premium	Free	Premium
  Age Range # 1	McdExtFreePct1	McdExtPremPct1	CHIPFreePct1	CHIPPremPct1
  Age Range # 2	McdExtFreePct2	McdExtPremPct2	CHIPFreePct2	CHIPPremPct2

  To measure a person's income, medicaid's own measure is modified by adding any lump-sum income (LumpSumIncomVars) that is to be treated as income (LumpSumTreatment). Beginning with version 56.5 of the Medicaid module SSI and TANF/AFDC benefits received by the family (SSIBenefitsReceived, AFDCBenefitsReceived) are not treated as income. To include SSI and TANF benefits in income one has to specify Opt #6 in the DebugOptions.
  This new income amount is then reduced by the deductions and disregards specified by the following rules (the values for these rules vary between Medicaid extension programs and separate state programs, but not between ages):

  	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

  See the dictionary definition of these rules for details regarding how these rules are applied. Note that in the Medicaid module, these disregards and deductions are applied to the entire year even if in the "real world" the disregards are only applied to part of the year (for example, the first four months).

SCHIP for Adults (eligibility type 74)

• Categorical Eligibility: To be considered a "parent", a person must be older than 18, be the head or spouse of a family (subfamilies are considered separately) and have at least one child of their own living with them who is 18 or younger. A person over 18 who does not meet all these criteria is classified as a "childless adult". A woman who is pregnant, in addition to being classified as "pregnant" will also be classified as a "parent" or "childless adult" if she is over 18. Note that for parents, if none of their children are eligible for medicaid, the parent will not be considered for eligibility either.

  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.

• Asset Test: The asset limits faced by each of these groups of adults are given by the rules CHIPParentAssetLimit, CHIPPregnantAssetLimit, and CHIPChildlessAdultAssetLimit. These limits vary by the family size, up to a size of 4. Assets are measured the same way as for SCHIP children.

• Income Test: The percent-of-poverty limits for each of these groups of adults are given by the rules CHIPParentPct, CHIPPregnantPct, and CHIPChildlessAdultPct. These percentages vary by whether or not a premium is charged for the coverage, and (for parents) by whether or not the person is already a recipient or is a new applicant. Income is determined in the same way as for SCHIP children, except that when applying deductions and disregards, only the values for separate state programs are used.

Medically Needy Eligibility (eligibility types 31-34 & 36-37)

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.

• Categorical Eligibility: States may choose whether or not to offer medically needy eligibility. If they do, they must provide coverage to pregnant women and children who are categorically eligible for one of the mandatory coverage groups (e.g. categorically eligible for TANF/AFDC or for the mandatory percent-of-poverty programs). States may choose to cover additional children under age 21, caretaker relatives, the elderly, and disabled individuals. The program rule MedicallyNeedyGroups specifies for each state which of the following groups are categorically eligible:
  • Pregnant women and infants
  • Children categorically eligible for TANF/AFDC
  • Children under a specified age (0 to 21)
  • Caretaker relatives (adults eligible to be aided along with their TANF/AFDC children)
  • Aged according to SSI rules
  • Disabled according to SSI rules
  Membership in the SSI-related groups is based on information passed from the SSI simulation via the rule SSIPersonType, while membership in the TANF/AFDC -related groups is based on information passed from an TANF/AFDC simulation via the rules AFDCPersonType and AFDCPassParentTest (this may be either a current-year TANF/AFDC simulation or a mandatory 1931 TANF simulation, depending upon whether pre or post-PRWORA rules are being simulated).

• Asset Test: The rules MedNeedyAssetLimitSize1-MedNeedyAssetLimitSize4 specify the asset limits, based on unit size. For persons in the SSI-related groups ,the value of assets and the unit size are obtained from the SSI simulation via the rules SSISimulatedUnitAssets and SSIUnitSize. For persons in the TANF/AFDC -related groups, while the unit size is obtained from the TANF/AFDC simulation via the rule AFDCUnitSize, the measure of assets depends upon the setting of the rule IncomeCalculationType , which in turn depends upon whether PRWORA rules are being simulated:
  • Post-PRWORA (IncomeCalculationType = 1): Medicaid's own measure of assets is used.
  • Pre-PRWORA (IncomeCalculationType = 0): The asset measure calculated for TANF/AFDC eligibility is used, which is passed from the TANF/AFDC simulation via the rule AFDCAssetsOfUnit. For persons not members of an TANF/AFDC unit, medicaid's own measure is used.

• Income Test: The rules MedNeedyIncomeLimitSize01-MedNeedyIncomeLimitSize10 specify the income limits, based on unit size. For persons in SSI-related groups, income and unit size are obtained from the SSI simulation via the rules SSISimulatedAvailableIncome and SSIUnitSize. Income and unit size for the TANF/AFDC -related groups are obtained from the TANF/AFDC simulation via the rules AFDCNetIncomeOfUnit and AFDCUnitSize. For persons not members of an TANF/AFDC unit, medicaid's own measure is used.

• Spend Down: For both SSI-related and TANF/AFDC -related groups, the income amount is reduced by an amount meant to approximate the unit's medical expenses. The medical expense amounts used to simulate this "spend down" are specified by the rules beginning "AvgMedicaidExpFor...", and vary by state and user group (children, adults, disabled, and elderly). In a baseline simulation, if an individual who falls within one of the groups covered by his/her state's medically needy program reported Medicaid benefits on the CPS but is not simulated as eligible that month through any of the non-medically needy rules, TRIM assumes that person has medical expenses high enough to "spend-down" to within the medically needy income limits. Such persons are automatically considered by TRIM3 to be income-eligible for the medically needy program, although they must still pass the asset test to be considered fully eligible. Such a person is also considered to be income-eligible for medically-needy coverage due to high medical expenses in all alternative simulations (assuming that the state is still being modeled as having a medically-needy program in the alternative).

  The Value of Medicaid/SCHIP Benefits

  TRIM3 estimates the "insurance value" of Medicaid coverage for each eligible individual. The imputation of insurance value uses regression equations plus adjustment factors to hit administrative targets.

  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.

  Determining Enrollment

  Monthly Enrollment Decision

  For each month that a person is simulated as eligible for Medicaid or SCHIP, a decision must be made as to whether the person is actually enrolled in the program in that month. A person may be simulated to enroll in some but not all of his/her months of eligibility. If a person is simulated to enroll in a given month, he/she is assigned an "Enrollment Type" value equal to the "Eligibility Type" value for that month.

  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 a SAS extract file be created using (among other things) results 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:
  1. Use the maximum person-level probability of enrollment
  2. Use the minimum person-level probablity of enrollment
  3. Use the average person-level probability of enrollment

  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%

  For details about how the baseline and alternative methods of enrollment were developed, click here. Also, note that prior to the 2002 baseline, monthly enrollment was determined within the medicaid module. Click here for details.

  Continuous Enrollment

  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.

  Annual Enrollment Category

  In addition to being assigned an "Enrollment Type" on a month-by-month basis, persons are also assigned an annual "Enrollment Type" using an "ever-on" concept - if an individual is enrolled for at least one month, s/he is considered to be enrolled on an annual basis as well. If the person is enrolled in more than one month, and the enrollment type varies from month to month, the 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):
  1. Mandatory eligibility: cash recipient
  2. Mandatory eligibility: other
  3. Optional eligibility
  4. SCHIP eligibility
  5. Medically Needy
  Note that this hierarchy is identical to the hierarchy used for determining the annual eligibility type. However, since it is possible for a person to be enrolled in some but not all of their eligible months, the type chosen for the annual enrollment type may be different from the type chosen for the annual eligibility type.

  Additional Information

  Post-PRWORA rule settings

  With the passage of PRWORA in 1996, significant changes occurred in Medicaid eligibility rules for families and children (rules covering aged and disabled were generally not affected). The primary change was the "de-linking" of Medicaid eligibility criteria from AFDC (now called TANF) eligibility criteria. In some cases, the link was completely dropped. In others it was kept but the criteria were allowed to deviate above or below pre-PRWORA AFDC levels. The most important of the remaining linkages were created by the new "Section 1931" of the Social Security Act. Under Section 1931 of the Act, states are required to provide Medicaid eligibility 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. States are also permitted to diverge from these plans.

  To simulate post-PRWORA rules, the rule IncomeCalculationType should be set to 1, and the following rules should be turned off:

  • AfdcAutoElig (set to 1)
  • DoesUPEligInNonUPQualForMcaid (set to 0 for all states)
  • DoesAFDCEligQualifyForMedicaid (set to 0 for all states)
  • BenefitsUnitEligForBelowMin (should be an empty list)
  In addition, special runs of the TANF/AFDC module that capture each state's Section 1931 eligibility requirements should be used as input to the medicaid simulation. Although most states have deviated from the minimum criteria (1996 AFDC eligibility rules) for Section 1931, the basic structure of the eligibility tests remains the same, so the TANF/AFDC module is best suited to simulate 1931 rules.

  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):

  • AFDCPersonType
  • AFDCUnitHead
  • AFDCUnitSize
  • AFDCPassAssetTest
  • AFDCPassGrossIncomeTest
  • AFDCPassNetIncomeTest
  • AFDCNetIncomeOfUnit
  • AFDCPassParentTest
  Note: The incorporation of post-PRWORA rules into the Medicaid module was actually done in two phases. The first phase encompassed the 1997 and 1998 baselines. In these years states had not diverged enough from pre-PRWORA eligibility criteria to warrant anything more than a simplified approach. In these years, while some de-linking from TANF/AFDC was simulated (IncomeCalculationType set to 1), all the rules in the AFDC Info category referred to the baseline TANF/AFDC run (there were no special 1931 TANF runs) and receipt of TANF/AFDC continued to make a person eligible (AfdcAutoElig set to 0). The rule DoesAFDCEligQualifyForMedicaid was used to simulate a simplified version of the 1931 rules by either assuming that they were the same as the state's TANF/AFDC rules for that year (value of 1), or by assuming that they were the same but eliminated the benefit test (value of 2). The former assumption usually meant that to be eligible, a person had to pass both the state's need standard and payment standard, while the latter usually meant that only the need standard had to be passed.

  Information from the SSI and TANF/AFDC Simulation

  As described elsewhere in this documentation, Medicaid eligibility is sometimes tied to the SSI program and the TANF/AFDC program. Consequently, the Medicaid module uses many variables produced by these modules. In general, the SSI results should come from the current year's baseline SSI simulation, unless the Medicaid simulation is being run to see the effect on Medicaid eligibility of changes in SSI rules. The TANF/AFDC results, however, generally come from 3 different TANF runs: the baseline, the mandatory 1931 run, and the optional 1931 run. Below is a complete list of all the rules through which the Medicaid module receives information from the SSI and TANF/AFDC modules:

  SSI:

  • AnnualSSIPersonEligType
  • SSIPersonType
  • SSISimulatedAvailableIncome
  • SSISimulatedUnitAssets
  • SSIPassAssetTest
  • SSIUnitSize
  • SSIUnitType
  • SSIBenefitsEligibleFor
  • SSIFederalBenefitsEligFor
  • SSIBenefitsReceived

  TANF/AFDC :

  • From the baseline TANF/AFDC run (unless medicaid is being run to see the impact of changes in TANF/AFDC rules):
    • AFDCBenefitsReceived
    • AfdcDeemedIncome
    • AFDCBenefitsEligFor
    • AFDCAssetsOfUnit
    • BenefitsUnitEligForBelowMin (only needed for pre-PRWORA simulations and post-PRWORA simulations using the "simple" (1997-1998) methodology)
  • From the mandatory 1931 TANF run (to simulate the fact that post-PRWORA Ribicoff and Medically Needy eligibility are linked to 1996 AFDC eligibility). If simulating pre-PRWORA rules, or post-PRWORA but using the "simple" (1997-1998) methodology, these should point to the same run as the previous group of rules:
    • AFDCPersonType
    • AFDCUnitHead
    • AFDCPassParentTest
    • AFDCUnitSize
    • AFDCNetIncomeOfUnit
    • AFDCPassAssetTest
    • AFDCPassNetIncomeTest
    • AFDCPassGrossIncomeTest
  • From the mandatory 1931 TANF run (when simulating 1931 eligibility by a special TANF run):
    • Mandatory1931Eligible
  • From the optional 1931 TANF run (when simulating 1931 eligibility by a special TANF run):
    • Optional1931Eligible

  Alternative Simulations

  An alternative (or non-baseline) simulation is one that models hypothetical or proposed rules rather than the actual rules that were in effect in a particular year. To set up an alternative simulation, do the following:
  • Set the SimulationMode to zero ("Alternative: Do not calculate gaps").
  • Specify the monthly result variable, EligibilityType from the baseline medicaid run in the rule BaselineEligibilityType.
  • Specify the annual result variable, AnnualEligibilityType from the baseline medicaid run in the rule AnnualBaselineEligibilityType.
  • If the old (i.e. in-model) enrollment method is being used, specify the annual result variable, ReasonForEnrollment from the baseline medicaid run in the rule AnnualBaselineEnrollmentReason.
  • Starting with version 56_2, when simulating pregnancy, PregnancyOption should be set to "2", and PregnancyIndicator should refer to the result variable IsPregnant from the baseline run.

  Reporters

  For various purposes, the Medicaid simulation needs to know whether a person should be considered a "reporter"--i.e. did they report being covered by Medicaid during the CPS interview. This determination is made as follows:

  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 eligible 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:

  1. Mandatory
  2. Optional
  3. SCHIP
  4. Medically Needy
  Months in one category are chosen before months in later categories (e.g. Mandatory months are chosen before SCHIP months, which in turn are chosen before Medically Needy months). If HealthMedicaidMonthsCovered = 0, reported coverage is assigned to all eligible months.

  Pregnancy

  Although pregnancy is not reported on CPS data, Medicaid eligibility based on pregnancy may be simulated by TRIM3, based on the value of the rule PregnancyOption :
  • 0: Pregnancy is not simulated
  • 1: Pregnancy is imputed within the medicaid module
  • 2: Pregnancy information is read in via the rule PregnancyIndicator
  Option #1 can only be used during a baseline run. This option imputes pregnancy to all female family heads and spouses who have an infant (i.e. 0-year old) in their family. This method of imputation is referred to as the "0-year old" method. Using this method, the woman is assumed to be pregnant in the months of April through December. In addition, a woman of child-bearing age (13-44) who reports receiving Medicaid, but is not simulated to be eligible by any of the non-pregnancy-based rules, is assumed to be pregnant in the months of July through December if doing so makes her eligible in at least one of those months. This method is referred to as the "ineligible reporter" method.

  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.

  Kinship Care

  The rules MedicaidKinshipCareOption and CHIPKinshipCareOption, in the Kinship Care category of rules control how medicaid measures income and assets for children who are not living with their parents (i.e. children under "kinship care"). Normally, the measure used is a family-level measure (or, when measuring income for medically needy eligibility, a TANF or SSI unit-level measure). However, these rules provide the option of just measuring the child's own assets and income

  Note that regardless of the setting of these rules, the normal measure will always be used if the family's income is above the level specified in the rule KinshipCareCeiling , or if SSI-based medically needy eligibility is being determined.