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Attachment 3i NHIS 2011 Flashcard Booklet
HIS-501(C) (2011)
R
EA
EN
UO
F TH E C
S
BU
US
U.S.
D
ENT OF C
TM
O
AR
CE
ER
M
M
EP
9-1-2010
U.S. DEPARTMENT
OF COMMERCE
NATIONAL
HEALTH
INTERVIEW
SURVEY
Economics and Statistics
Administration
U.S. CENSUS BUREAU
Field
Representative’s
Flashcard and
Information
Booklet
USCENSUSBUREAU
Draft 4 (10-18-2010)
CARD HM
WHO IS TO BE INCLUDED AS A HOUSEHOLD MEMBER
A. PERSONS LIVING OR STAYING IN SAMPLE UNIT AT TIME OF
INTERVIEW
Any person in unit: members of family, lodgers, service staff,
visitors, etc.
1. Ordinarily stay here all the time (sleep here)
2. Here temporarily – no living quarters held for person elsewhere
3. Here temporarily – living quarters held for person elsewhere
In Armed Forces
1. Stationed in this locality, usually sleep here
2. Temporarily here on leave – stationed elsewhere
Student – Post-Secondary and/or Nursing School
1. Staying here, attending school
2. Here temporarily for summer vacation – no living quarters
held for person elsewhere
3. Here temporarily for break or visiting – living quarters held
for person elsewhere
Include as
member of
household
Yes
Yes
No
Yes
No
Yes
Yes
No
B. ABSENT PERSONS WHO USUALLY LIVE HERE
Persons living in institutionalized Group Quarters (GQs) – Absent
because person living in an institution (see Field Representative Manual
Appendix B.1) regardless of whether or not living quarters held for person
at sample address.
Persons temporarily absent, on vacation, in general hospital, etc.
(including veterans’ facilities that are general hospitals) – Living
quarters held here for person
Absent in connection with job
1. Living quarters held here for person – temporarily absent while
"on the road" in connection with job (e.g., persons on work-related
travel, long-distance truck driver)
2. Living quarters held here and elsewhere for person who comes
here infrequently (e.g., construction engineers, mission workers)
3. Living quarters held here at home for unmarried college student
working away from home during summer school vacation
No
Yes
Yes
No
Yes
In Armed Forces – Were members of this household at time of
induction but currently stationed elsewhere
No
No
In school – Away attending post-secondary or nursing school
– Away attending boarding school
Yes
Persons who work at sea – Living quarters held here for person
Yes
C. EXCEPTIONS AND DOUBTFUL CASES
Person with two concurrent residences
1. Regularly sleep greater part of week in another locality
2. Regularly sleep greater part of week here
Citizens of foreign countries temporarily in the United States
1. Living on premises of an Embassy, Ministry, Legation,
Chancellery, or Consulate
2. Not living on premises of an Embassy, Ministry, etc. –
a. If living and studying here and no usual place of
residence elsewhere in the United States
b. If living and working here and no usual place of
residence elsewhere in the United States
c. If merely visiting or traveling in the United States
HIS-501(C) (9-1-2010)
Page 2
No
Yes
No
Yes
Yes
No
Draft 4 (10-18-2010)
Type A Noninterviews
Type B Noninterviews
Type C Noninterviews
Partial Interviews
Classification of Living Quarters Problems
WHEN TO SEND AN EMAIL TO THE
REGIONAL OFFICE
Problems trying to list and update an address
Additional and EXTRA Units
Merged Units
Replaced Sample Unit Structure
Permit address found to contain more or fewer units than expected
Permit address found to be in a Group Quarters
Abandoned Permit
Segment boundary problems
Problems encountered trying to classify the type of living quarters
Unable to locate a sample address
HIS-501(C) (9-1-2010)
Page 3
Card HM
When to Fill F7 and Send
Email
WHEN TO FILL THE F7
CASE MANAGEMENT NOTES
Draft 4 (10-18-2010)
2010
JANUARY
S M T W T F
1
3 4 5 6 7 8
10 11 12 13 14 15
17 18 19 20 21 22
24 25 26 27 28 29
31
FEBRUARY
S M T W T F
JULY
S M T W T
1
4 5 6 7 8
11 12 13 14 15
18 19 20 21 22
25 26 27 28 29
S
2
9
16
23
30
S
F
5
12
19
26
S
6
13
20
27
APRIL
S M T W T
1
4 5 6 7 8
11 12 13 14 15
18 19 20 21 22
25 26 27 28 29
F
2
9
16
23
30
S
3
10
17
24
MAY
S M T W T
F
7
14
21
28
S
1
8
15
22
29
F
4
11
18
25
S
5
12
19
26
2
9
16
23
30
S
6
13
20
27
3 4 5 6
10 11 12 13
17 18 19 20
24 25 26 27
31
JUNE
M T W T
1 2 3
7 8 9 10
14 15 16 17
21 22 23 24
28 29 30
F
6
13
20
27
S
7
14
21
28
SEPTEMBER
S M T W T F
S
M
2
9
16
23
30
AUGUST
T W T
3 4 5
10 11 12
17 18 19
24 25 26
31
1 2 3 4
5 6 7 8 9 10 11
12 13 14 15 16 17 18
19 20 21 22 23 24 25
26 27 28 29 30
OCTOBER
S M T W T F
1
3 4 5 6 7 8
10 11 12 13 14 15
17 18 19 20 21 22
24 25 26 27 28 29
31
NOVEMBER
S M T W T F
S
2
9
16
23
30
S
1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28 29 30
DECEMBER
S M T W T F
1 2 3
5 6 7 8 9 10
12 13 14 15 16 17
19 20 21 22 23 24
26 27 28 29 30 31
Federal Holiday (observed)
HIS-501(C) (9-1-2010)
S
3
10
17
24
31
S
1
8
15
22
29
1 2 3 4 5 6
7 8 9 10 11 12 13
14 15 16 17 18 19 20
21 22 23 24 25 26 27
28
MARCH
S M T W T
1 2 3 4
7 8 9 10 11
14 15 16 17 18
21 22 23 24 25
28 29 30 31
F
2
9
16
23
30
Page 4
S
4
11
18
25
Draft 4 (10-18-2010)
2011
JANUARY
S M T W T F
2
9
16
23
30
3 4 5 6 7
10 11 12 13 14
17 18 19 20 21
24 25 26 27 28
31
S
5
12
19
26
MARCH
S M T W T
1 2 3
6 7 8 9 10
13 14 15 16 17
20 21 22 23 24
27 28 29 30 31
F
4
11
18
25
S
5
12
19
26
F
1
8
15
22
29
S
2
9
16
23
30
F
6
13
20
27
S
7
14
21
28
3 4 5 6 7
10 11 12 13 14
17 18 19 20 21
24 25 26 27 28
S
1
8
15
22
29
M
2
9
16
23
30
MAY
T W T
3 4 5
10 11 12
17 18 19
24 25 26
31
JUNE
S M T W T
1 2
5 6 7 8 9
12 13 14 15 16
19 20 21 22 23
26 27 28 29 30
3 4 5 6
10 11 12 13
17 18 19 20
24 25 26 27
31
S M
1
7 8
14 15
21 22
28 29
AUGUST
T W T
2 3 4
9 10 11
16 17 18
23 24 25
30 31
S
2
9
16
23
30
F
5
12
19
26
S
6
13
20
27
SEPTEMBER
S M T W T F
1 2
4 5 6 7 8 9
11 12 13 14 15 16
18 19 20 21 22 23
25 26 27 28 29 30
OCTOBER
S M T W T F
2
9
16
23
30
3 4 5 6 7
10 11 12 13 14
17 18 19 20 21
24 25 26 27 28
31
NOVEMBER
S M T W T F
6 7
13 14
20 21
27 28
Page 5
S
3
10
17
24
S
1
8
15
22
29
S
1 2 3 4 5
8 9 10 11 12
15 16 17 18 19
22 23 24 25 26
29 30
DECEMBER
S M T W T F
1 2
4 5 6 7 8 9
11 12 13 14 15 16
18 19 20 21 22 23
25 26 27 28 29 30
F S
3 4
1011
1718
2425
Federal Holiday (observed)
HIS-501(C) (9-1-2010)
7
14
21
28
F
1
8
15
22
29
S
3
10
17
24
31
Calendar – 2010
Calendar – 2011
FEBRUARY
S M T W T F
1 2 3 4
6 7 8 9 10 11
13 14 15 16 17 18
20 21 22 23 24 25
27 28
APRIL
S M T W T
JULY
S M T W T
S
1
8
15
22
29
Draft 4 (10-18-2010)
HIS-501(C) (9-1-2010)
Page 6
Draft 4 (10-18-2010)
HOLIDAYS*
2010
New Year’s Day
January 1
Martin Luther King’s Birthday
January 18
President’s Day
February 15
Easter
April 4
Memorial Day
May 31
Independence Day
July 5
Labor Day
September 6
Columbus Day
October 11
Veteran’s Day
November 11
Thanksgiving
November 25
Christmas
December 24
Holidays – 2010 & 2011
2011
New Year’s Day
December 31, 2010
Martin Luther King’s Birthday
January 17
President’s Day
February 21
Easter
April 24
Memorial Day
May 30
Independence Day
July 4
Labor Day
September 5
Columbus Day
October 10
Veteran’s Day
November 11
Thanksgiving
November 24
Christmas
December 26
*Federal Holidays (observed), except Easter
HIS-501(C) (9-1-2010)
Page 7
Draft 4 (10-18-2010)
CARD H1
You may choose more than one.
1. Puerto Rican
2. Cuban/Cuban American
3. Dominican (Republic)
4. Mexican
5. Mexican American
6. Central or South American
7. Other Latin American
8. Other Hispanic/Latino/Spanish
HIS-501(C) (9-1-2010)
Page 8
Draft 4 (10-18-2010)
CARD H2
You may choose more than one.
1. White
2. Black/African American
3. Indian (American)
4. Alaska Native
5. Native Hawaiian
6. Guamanian
7. Samoan
8. Other Pacific Islander
9. Asian Indian
10. Chinese
11. Filipino
13. Korean
14. Vietnamese
15. Other Asian
HIS-501(C) (9-1-2010)
Page 9
Card H1
Card H2
12. Japanese
Draft 4 (10-18-2010)
HIS-501(C) (9-1-2010)
Page 10
Draft 4 (10-18-2010)
CARD H3
2. Spouse (husband/wife)
3. Unmarried Partner
4. Child (biological/adoptive/in-law/
step/foster)
5. Child of Partner
6. Grandchild
7. Parent (biological/adoptive/in-law/
step/foster)
8. Brother/Sister (biological/adoptive/in-law/
step/foster)
9. Grandparent (Grandmother/Grandfather)
10. Aunt/Uncle
11. Niece/Nephew
12. Other relative
13. Housemate/Roommate
14. Roomer/Boarder
15. Other non-relative
16. Legal Guardian
17. Ward
Card H3
HIS-501(C) (9-1-2010)
Page 11
Draft 4 (10-18-2010)
CARD F1
You may choose more than one.
1. Vision/problem seeing
2. Hearing problem
3. Speech problem
4. Asthma/breathing problem
5. Birth defect
6. Injury
7. Intellectual disability, also known
as mental retardation
8. Other developmental problem
(for example, cerebral palsy)
9. Other mental, emotional, or
behavioral problem
10. Bone, joint, or muscle problem
11. Epilepsy or seizures
12. Learning disability
13. Attention Deficit/Hyperactivity
Disorder (ADD/ADHD)
Other impairment/problem
HIS-501(C) (9-1-2010)
Page 12
Draft 4 (10-18-2010)
CARD F2
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture or bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (for example,
asthma and emphysema)
12. Cancer
13. Birth defect
14. Intellectual disability, also known
as mental retardation
15. Other developmental problem
(for example, cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
HIS-501(C) (9-1-2010)
Page 13
Card F1
Card F2
You may choose more than one.
Draft 4 (10-18-2010)
CARD F3
Beginning
1
2
3
8
9
10
4
5
6
7
11
12
13
14
18
19
20
Middle
15
16
17
21
End
22
23
24
29
30
31
HIS-501(C) (9-1-2010)
25
Page 14
26
27
28
Draft 4 (10-18-2010)
CARD F4
You may choose up to four.
Head
Neck
Chest
Upper arm
Back
Elbow
Forearm
Stomach
Buttocks
Wrist
Groin
Hand
Finger/Thumb
Thigh
Knee
Hip
Lower leg
Ankle
Foot
Toe
Eye
Ear
Nose
Mouth
Teeth
Jaw
Face
HIS-501(C) (9-1-2010)
Page 15
Card F3
Card F4
Shoulder
Draft 4 (10-18-2010)
CARD F5
You may choose up to two.
1. Broken bone or fracture
2. Sprain, strain, or twist
3. Cut
4. Scrape
5. Bruise
6. Burn
7. Insect bite
8. Animal bite
9. Other (specify)
HIS-501(C) (9-1-2010)
Page 16
Draft 4 (10-18-2010)
CARD F6
1. Passenger car
2. Passenger truck, such as a pickup
truck, van, or SUV
3. Bus
4. Large commercial truck, such as a
semi-truck, big rig, or 18-wheeler
5. Motorcycle (including mopeds,
minibikes)
6. All terrain vehicle or ski/snow-mobile
7. Farm equipment (such as a tractor)
8. Industrial or construction vehicle
Card F5
Card F6
9. Other
HIS-501(C) (9-1-2010)
Page 17
Draft 4 (10-18-2010)
CARD F7
You may choose up to two.
On, down, from, or into:
1. Stairs, steps, or escalator
2. Floor or level ground
3. Curb (including sidewalk)
4. Ladder or scaffolding
5. Playground equipment
6. Sports field, court, or rink
7. Building or other structure
8. Chair, bed, sofa, or other furniture
9. Bathtub, shower, toilet, or commode
10. Hole or other opening
11. Other
HIS-501(C) (9-1-2010)
Page 18
Draft 4 (10-18-2010)
CARD F8
1. Slipping or tripping
2. Jumping or diving
3. Bumping into an object or another person
4. Being shoved or pushed by another person
5. Losing balance or having dizziness
(becoming faint or having a seizure)
6. Other
Card F7
Card F8
HIS-501(C) (9-1-2010)
Page 19
Draft 4 (10-18-2010)
CARD F9
1. Swallowing a drug or medical substance
mistakenly or in overdose
2. Swallowing or touching a harmful solid or
liquid substance
3. Inhaling harmful gases or vapors
4. Eating a poisonous plant or other
substance mistaken for food
5. Being bitten by a poisonous animal
6. Other (specify)
HIS-501(C) (9-1-2010)
Page 20
Draft 4 (10-18-2010)
CARD F10
You may choose up to two.
1. Driving or riding in a motor vehicle
2. Working at a paid job
3. Working around the house or yard
4. Attending school
5. Unpaid work (such as volunteer work)
6. Sports and exercise
7. Leisure activity (excluding sports)
8. Sleeping, resting, eating, or drinking
9. Cooking
10. Being cared for (hands-on care from
other person)
11. Other (specify)
Card F9
Card F10
HIS-501(C) (9-1-2010)
Page 21
Draft 4 (10-18-2010)
CARD F11
You may choose up to two.
1. Home (inside)
2. Home (outside)
3. School (not residential)
4. Child care center or preschool
5. Residential institution (excluding
hospital)
6. Health care facility (including hospital)
7. Street or highway
8. Sidewalk
9. Parking lot
10. Sport facility, athletic field, or
playground
11. Shopping center, restaurant, store,
bank, gas station, or other place of
business
12. Farm
13. Park or recreation area (including bike or
jog path)
14. River, lake, stream, or ocean
15. Industrial or construction area
16. Other public building
17. Other
HIS-501(C) (9-1-2010)
Page 22
Draft 4 (10-18-2010)
You may choose more than one.
1. Private health insurance*
2. Medicare
3. Medi-Gap
4. Medicaid
5. CHIP (SCHIP/Children’s Health
Insurance Program)
6. Military health care
(TRICARE/VA/CHAMP-VA)
7. Indian Health Service
8. State-sponsored health plan
9. Other government program
10. Single service plan (e.g., dental, vision,
prescriptions)
11. No coverage of any type
*EXCLUDE private plans that only provide
extra cash while hospitalized.
HIS-501(C) (9-1-2010)
Page 23
Card F11
Card F12
CARD F12
Draft 4 (10-18-2010)
CARD F13
MEDICARE
HEALTH INSURANCE
E
L
P
1-800-MEDICARE (1-800-633-4227)
NAME OF BENEFICIARY
JOHN Q. PUBLIC
CLAIM NUMBER
M
A
000–00–0000–A
IS ENTITLED TO
HOSPITAL
MEDICAL
SIGN
HERE
HIS-501(C) (9-1-2010)
S
SEX
MALE
EFFECTIVE DATE
(PART A) 07–01–1986
(PART B) 07–01–1986
Page 24
Draft 4 (10-18-2010)
Card F13
Card F14 - All States
HIS-501(C) (9-1-2010)
Page 25
Draft 4 (10-18-2010)
HIS-501(C) (9-1-2010)
Page 26
Draft 4 (10-18-2010)
CARD F14-AL
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
ALABAMA
Medicaid: Patient 1st; SOBRA
CHIP: AL-Kids; ALL KIDS
State/Other: Children’s Rehabilitation
Service (CRS); Alabama Child
Caring Plan; Alabama Health
Insurance Plan (AHIP)
HIS-501(C) (9-1-2010)
Page 27
Draft 4 (10-18-2010)
CARD F14-AK
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
ALASKA
Medicaid: Alaska Medicaid
CHIP: Denali KidCare
State/Other: Chronic and Acute Medical
Assistance (CAMA); Health Care
Program for Children with
Special Health Care Needs
(HCP-CSN); Alaska
Comprehensive Health
Insurance Association (ACHIA)
HIS-501(C) (9-1-2010)
Page 28
Draft 4 (10-18-2010)
CARD F14-AZ
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
ARIZONA
Medicaid: AHCCCS; Arizona Health Care
Cost Containment System; Baby
Arizona; Healthy Arizona; SOBRA
CHIP: KidsCare
State/Other: Medically Indigent – Medically
Needy Program (MI/MN); Office
for Children with Special Health
Care Needs (CSHCN); Freedom
to Work; Young Adults
Transitional Insurance (YATI)
HIS-501(C) (9-1-2010)
Page 29
Draft 4 (10-18-2010)
CARD F14-AR
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
ARKANSAS
Medicaid: ConnectCare; Katie Beckett; TEFRA;
ARKids First A; HIFA Waiver Safety
Net Benefit Program
CHIP: ARKids First B
State/Other: Arkansas Comprehensive Health
Insurance Plan; Children’s
Medical Services (CMS)
HIS-501(C) (9-1-2010)
Page 30
Draft 4 (10-18-2010)
CARD F14-CA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
CALIFORNIA
Medicaid: Medi-Cal; Health Insurance
Premium Payment Program (HIPP)
CHIP: Healthy Families Program (HFP)
State/Other: Access for Infants & Mothers
(AIM); County Medical Services
Program (CMSP); California
Children’s Services (CCS); Major
Risk Medical Insurance Program
(MRMIP); CARE Health Insurance
Premium Payment Program;
California Major Risk Medical
Insurance Program; Healthy Kids
Program
HIS-501(C) (9-1-2010)
Page 31
Draft 4 (10-18-2010)
CARD F14-CO
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
COLORADO
Medicaid: Primary Care Physician Program
(PCPP); Baby Care/Kids Care;
Health Colorado
CHIP: Child Health Plan Plus (CHP+);
Childrens Basic Health Plan
State/Other: Health Care Program for
Children with Special Needs
(HCP); CUHIP - Colorado
Uninsurable Health Insurance
Plan; CoverColorado; Colorado
Indigent Care Program (CICP)
HIS-501(C) (9-1-2010)
Page 32
Draft 4 (10-18-2010)
CARD F14-CT
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
CONNECTICUT
Medicaid: Medical Assistance Program;
HUSKY Part A
CHIP: The HUSKY Plan; HUSKY PLUS;
HUSKY Part B
State/Other: Refugee Medical Assistance;
Children with Special Health
Care Needs; Connecticut Health
Reinsurance Association (HRA);
Connecticut Insurance
Assistance Program for AIDS
Patients (CIAPAP);
State-Administered General
Assistance Medical Aid (SAGA);
Family Health Services Division
(BCH)
HIS-501(C) (9-1-2010)
Page 33
Draft 4 (10-18-2010)
CARD F14-DE
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
DELAWARE
Medicaid: Diamond State Health Plan
CHIP: Healthy Children; Delaware Healthy
Children Program (DHCP)
State/Other: Children with Special Health
Care Needs (CSHCN)
HIS-501(C) (9-1-2010)
Page 34
Draft 4 (10-18-2010)
CARD F14-DC
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
DISTRICT OF COLUMBIA
Medicaid: Medical Assistance
CHIP: DC Healthy Families; DC Healthy Kids
State/Other: Medical Charities Program;
Health Services for Children
with Special Needs; DC
Healthcare Alliance
HIS-501(C) (9-1-2010)
Page 35
Draft 4 (10-18-2010)
CARD F14-FL
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
FLORIDA
Medicaid: MediPass
CHIP: KidCare; MediKids; Florida Healthy Kids
State/Other: AIDS Insurance Continuation
Program (AICP); Florida
Comprehensive Health
Association; Children’s Medical
Services (CMS)
HIS-501(C) (9-1-2010)
Page 36
Draft 4 (10-18-2010)
CARD F14-GA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
GEORGIA
Medicaid: Right from the Start (RSM); Health
Insurance Premium Payment
Program (HIPP); Katie
Beckett/TEFRA; Georgia Healthy
Families
CHIP: PeachCare for Kids; Georgia Healthy
Families
State/Other: Children’s Medical Services
(CMS); Indigent Care Trust Fund
(ICTF)
HIS-501(C) (9-1-2010)
Page 37
Draft 4 (10-18-2010)
CARD F14-HI
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
HAWAII
Medicaid: Hawaii-QUEST
CHIP: Hawaii CHIP
State/Other: QUEST-Net; H-COBRA; Children
with Special Health Needs;
Quest Adult Coverage
Expansion Program (ACE);
Transitional Medical Assistance
Program (TMA); State Medical
Assistance for Immigrant
Children Program
HIS-501(C) (9-1-2010)
Page 38
Draft 4 (10-18-2010)
CARD F14-ID
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
IDAHO
Medicaid: Healthy Connections; Medical
Assistance
CHIP: Children’s Health Insurance Program;
CHIP-A; CHIP-B; Access Card
State/Other: Catastrophic Fund; Children’s
Special Health Program (CSHP);
Access to Health Insurance
Program; Individual High Risk
Reinsurance Pool Plan (HRP)
HIS-501(C) (9-1-2010)
Page 39
Draft 4 (10-18-2010)
CARD F14-IL
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
ILLINOIS
Medicaid: Medical Assistance; Healthy Start;
Family-Care; Parent Assist; Assist;
Moms and Babies; Illinois Health
Connect; All Kids
CHIP: All Kids
State/Other: Comprehensive Health
Insurance Plan (ICHIP);
Specialized Care for Children
(DSCC); Health Care for Workers
with Disabilities (HBWD)
HIS-501(C) (9-1-2010)
Page 40
Draft 4 (10-18-2010)
CARD F14-IN
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
INDIANA
Medicaid: Hoosier Healthwise; Risk Based
Managed Care (RBMC); Medicaid
CareSelect
CHIP: Hoosier Healthwise for Children;
Children’s Health Plan; Benefit
Package C
State/Other: Children’s Special Health Care
Services (CSHCS); Indiana
Comprehensive Health
Insurance Association (ICHIA);
MEDworks; Healthy Indiana
Plan (HIP)
HIS-501(C) (9-1-2010)
Page 41
Draft 4 (10-18-2010)
CARD F14-IA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
IOWA
Medicaid: Medical Assistance; Health
Insurance Premium Payment
(HIPP); MediPASS; Iowa Plan
CHIP: Health and Well Kids in Iowa (HAWK-I)
State/Other: Children’s Health Specialty
Clinics (CHSC); Iowa
Comprehensive Health
Association; AIDS/HIV Health
Insurance Premium Payment;
IowaCare; Health Insurance
Plan of Iowa
HIS-501(C) (9-1-2010)
Page 42
Draft 4 (10-18-2010)
CARD F14-KS
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
KANSAS
Medicaid: HealthConnect; HealthWave 19;
Kansas Medical Assistance
Program (KMAP)
CHIP: HealthWave 21
State/Other: Medi-KAN (MKN); Services for
Children with Special Health
Care Needs (CSHSN); Kansas
Uninsurable Health Insurance
Plan; Kansas Health Insurance
Association (KHIA)
HIS-501(C) (9-1-2010)
Page 43
Draft 4 (10-18-2010)
CARD F14-KY
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
KENTUCKY
Medicaid: Kentucky Patient Access and Care
System (KenPAC); KY
HealthChoices; Global Choices
CHIP: Kentucky Children’s Health Insurance
Program (KCHIP); Family Choices
State/Other: Kentucky HIV Health Insurance
Assistance Program;
Commission for Children with
Special Health Care Needs;
Kentucky Access
HIS-501(C) (9-1-2010)
Page 44
Draft 4 (10-18-2010)
CARD F14-LA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
LOUISIANA
Medicaid: CommunityCARE; LaMoms
CHIP: LACHIP
State/Other: Louisiana Health Plan;
Children’s Special Health
Services; Louisiana Health
Insurance Association
HIS-501(C) (9-1-2010)
Page 45
Draft 4 (10-18-2010)
CARD F14-ME
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
MAINE
Medicaid: MaineCare
CHIP: MaineCare
State/Other: Children with Special Health
Care Needs Program (CSHNP)
HIS-501(C) (9-1-2010)
Page 46
Draft 4 (10-18-2010)
CARD F14-MD
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
MARYLAND
Medicaid: Medical Assistance Program;
HealthChoice; REM Program
CHIP: Maryland Children’s Health Program
(MCHP); HealthChoice
State/Other: AIDS Insurance Assistance
Program (MAIAP); Children’s
Medical Services (CMS); Primary
Adult Care (PAC); Maryland
Health Insurance Plan
HIS-501(C) (9-1-2010)
Page 47
Draft 4 (10-18-2010)
CARD F14-MA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
MASSACHUSETTS
MASSACHUSETTS
Medicaid: MassHealth
CHIP: MassHealth
State/Other: Children’s Medical Security Plan
(CMSP); Commonhealth; Medical
Security Plan (MSP); Special
Kids/Special Care; Insurance
Partnership; Division of Special
Health Care Needs;
Uncompensated Care Pool (UCP)
HIS-501(C) (9-1-2010)
Page 48
Draft 4 (10-18-2010)
CARD F14-MI
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
MICHIGAN
Medicaid: Medical Assistance Program;
Healthy Kids; MICHOICE
CHIP: MIChild Program
State/Other: Children’s Special Health Care
Services (CSHCS); Trust Fund
for Children with Special Health
Care Needs
HIS-501(C) (9-1-2010)
Page 49
Draft 4 (10-18-2010)
CARD F14-MN
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
MINNESOTA
Medicaid: Medical Assistance (MA)
CHIP: Children’s Health Insurance Program
State/Other: Minnesota Care; Minnesota
General Assistance Medical
Care Program (GAMC); HIV/AIDS
Insurance Continuation
Program; Minnesota Children
with Special Health Care Needs
(MCSHN); Minnesota
Comprehensive Health
Association (MCHA)
HIS-501(C) (9-1-2010)
Page 50
Draft 4 (10-18-2010)
CARD F14-MS
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
MISSISSIPPI
Medicaid: Medicaid; Medical Assistance
Program; Infant Survival Program
CHIP: Mississippi Children’s Health Insurance
Program (CHIP)
State/Other: Mississippi Comprehensive
Health Insurance Risk Pool;
Children with Special Health
Care Needs
HIS-501(C) (9-1-2010)
Page 51
Draft 4 (10-18-2010)
CARD F14-MO
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19", or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
MISSOURI
Medicaid: MO Healthnet; Managed Care Plus
(MC+); MCPlus
CHIP: MO Healthnet for kids with premiums;
MC+ for Kids
State/Other: General Relief Medical
Assistance; Children with
Special Health Care Needs;
Missouri Health Insurance Pool
(MHIP)
HIS-501(C) (9-1-2010)
Page 52
Draft 4 (10-18-2010)
CARD F14-MT
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
MONTANA
Medicaid: Passport to Health; Healthy
Montana Kids Plus
CHIP: Montana’s CHIP; Healthy Montana
Kids Plus
State/Other: Montana Comprehensive Health
Insurance Association (MCHA);
Health Insurance Continuum of
Coverage Program (HICCP);
Children’s Special Health
Services (SHS)
HIS-501(C) (9-1-2010)
Page 53
Draft 4 (10-18-2010)
CARD F14-NE
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
NEBRASKA
Medicaid: Medical Assistance Program;
Nebraska Health Connection
(NHC)
CHIP: Kids Connection
State/Other: Medically Handicapped
Children’s Program (MHCP);
Comprehensive Health
Insurance Pool
HIS-501(C) (9-1-2010)
Page 54
Draft 4 (10-18-2010)
CARD F14-NV
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
NEVADA
Medicaid: Nevada Medicaid; Child Assurance
Program (CHAP)
CHIP: Nevada Check Up
State/Other: Family Health Services Bureau;
Children with Special Health
Care Needs
HIS-501(C) (9-1-2010)
Page 55
Draft 4 (10-18-2010)
CARD F14-NH
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
NEW HAMPSHIRE
Medicaid: New Hampshire Medicaid; Healthy
Kids Gold; Health Insurance
Premium Payment Program (HIPP)
CHIP: Healthy Kids Silver
State/Other: Special Medical Services
(SMSB); Healthy Kids Buy-in;
Catastrophic Illness Program;
New Hampshire Health Plan
HIS-501(C) (9-1-2010)
Page 56
Draft 4 (10-18-2010)
CARD F14-NJ
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
NEW JERSEY
Medicaid: New Jersey Medicaid; AIDS
Community Care Alternatives
(ACCAP)
CHIP: New Jersey Family Care/New Jersey
Kid Care
State/Other: Health Insurance Continuation
Program (HICP); Special Child
Adult and Early Intervention
Services (SCAEIS); New Jersey
Family Care Advantage
HIS-501(C) (9-1-2010)
Page 57
Draft 4 (10-18-2010)
CARD F14-NM
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
NEW MEXICO
Medicaid: SALUD!
CHIP: New MexiKids; New MexiTeens
State/Other: Insurance Assistance Program;
Children’s Medical Services
(CMS); New Mexico Medical
Insurance Pool (NMMIP); New
Mexico Health Insurance
Alliance (NMHIA);
New Mexico State Coverage
Insurance (NMSCI); Premium
Assistance for Kids (PAK)
HIS-501(C) (9-1-2010)
Page 58
Draft 4 (10-18-2010)
CARD F14-NY
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
NEW YORK
Medicaid: The Partnership Plan; Medicaid
CHIP: Child Health Plus
State/Other: Family Health Plus; FHPlus;
Healthy New York; Physically
Handicapped Children’s
Program; Children with Special
Health Care Needs Program
(CSHCN); ADAP Plus Insurance
Continuation Program (APIC)
HIS-501(C) (9-1-2010)
Page 59
Draft 4 (10-18-2010)
CARD F14-NC
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
NORTH CAROLINA
Medicaid: Carolina Access; HealthCare
Connection; CCNC/CA
CHIP: NC CHIP Program; NC Health Choice
for Children (NCHC)
State/Other: Title V Services for Children
with Special Health Care Needs;
North Carolina Health Insurance
Risk Pool (NCHIRP)
HIS-501(C) (9-1-2010)
Page 60
Draft 4 (10-18-2010)
CARD F14-ND
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
NORTH DAKOTA
Medicaid: Primary Care Provider Program;
Primary Care Case Management
CHIP: Healthy Steps Program
State/Other: Comprehensive Health
Association of North Dakota
(CHAND); Children’s Special
Health Services (CSHS)
HIS-501(C) (9-1-2010)
Page 61
Draft 4 (10-18-2010)
CARD F14-OH
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
OHIO
Medicaid: Healthy Families; Healthy Start
CHIP: Healthy Start
State/Other: HIV Health Insurance Premium
Payment Program (HIPP);
Hemophilia Insurance Pilot
Program; Bureau for Children
with Medical Handicaps (BCMH)
HIS-501(C) (9-1-2010)
Page 62
Draft 4 (10-18-2010)
CARD F14-OK
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or {State}
Medicaid," such as "Alabama Medicaid." CHIP or
S-CHIP programs can also be under "Title XXI
Program" or "{State} CHIP," such as "Pennsylvania
CHIP." The names provided below offer additional
names for the public health insurance programs
for each state.
OKLAHOMA
Medicaid: SoonerCare Plus; SoonerCare
Choice
CHIP: Oklahoma SCHIP
State/Other: Children with Special Health
Care Needs (CSHCN); Oklahoma
Health Insurance High Risk Pool;
Oklahoma Employer/Employee
Partnership for Insurance
Coverage (O-EPIC)
HIS-501(C) (9-1-2010)
Page 63
Draft 4 (10-18-2010)
CARD F14-OR
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
OREGON
Medicaid: Oregon Health Plan (OHP)
CHIP: Oregon SCHIP
State/Other: CareAssist; Oregon Services for
Children with Special Health
Needs; Oregon Medical
Insurance Pool (OMIP); Family
Health Insurance Assistance
Program (FHIAP); Insurance
Purchasing Cooperative; Child
Development and Rehabilitation
Center
HIS-501(C) (9-1-2010)
Page 64
Draft 4 (10-18-2010)
CARD F14-PA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
PENNSYLVANIA
Medicaid: Medical Assistance; Access Card;
HealthChoices; Access Plus
CHIP: Pa CHIP
State/Other: Title V Program; Bureau of
Family Health; Health Insurance
Premium Payment Program;
Adult Basic
HIS-501(C) (9-1-2010)
Page 65
Draft 4 (10-18-2010)
CARD F14-RI
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
RHODE ISLAND
Medicaid: RIte Care; RI Medical Assistance;
Katie Beckett
CHIP: RIte Care
State/Other: Subsidy for Health Insurance
for Center-Based Child-Care
Providers; Office of Children
with Special Health Care Needs
(OCSHN); Rlte Share Premium
Assistance Program; Child Care
Provider RIte Care Program
(CCPRC)
HIS-501(C) (9-1-2010)
Page 66
Draft 4 (10-18-2010)
CARD F14-SC
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
SOUTH CAROLINA
Medicaid: Healthy Connections; Healthy
Options Program (HOP);
Physicians Enhanced Program
(PEP); Partners for Healthy
Children (PHC); Health
Opportunity Accounts (HOA)
CHIP: Healthy Connections Kids
State/Other: South Carolina Health Insurance
Pool; Children’s Rehabilitative
Services (CRS); Medically
Indigent Assistance Program
(MIAP); Medically Fragile
Children’s Program
HIS-501(C) (9-1-2010)
Page 67
Draft 4 (10-18-2010)
CARD F14-SD
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
SOUTH DAKOTA
Medicaid: Medical Assistance; Medicaid
CHIP: CHIP
State/Other: Catastrophic County-Poor Relief
Program (CCPR); Continuation
of Health Insurance; Children’s
Special Health Services (CSHS);
Refugee Medical Assistance;
South Dakota Risk Pool;
Disabled Children’s Program
HIS-501(C) (9-1-2010)
Page 68
Draft 4 (10-18-2010)
CARD F14-TN
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
TENNESSEE
Medicaid: TennCare
CHIP: Cover Kids
State/Other: Children’s Special Services
(CSS); CoverTN; Access TN
HIS-501(C) (9-1-2010)
Page 69
Draft 4 (10-18-2010)
CARD F14-TX
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
TEXAS
Medicaid: State of Texas Access Reform
(STAR); Star+Plus
CHIP: Texas CHIP
State/Other: Texas Health Insurance Risk
Pool; State Kid Insurance
Program (SKIP); Children with
Special Health Care Needs
(CSHCN)
HIS-501(C) (9-1-2010)
Page 70
Draft 4 (10-18-2010)
CARD F14-UT
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
UTAH
Medicaid: Medicaid
CHIP: Children’s Health Insurance Program
State/Other: Utah’s Primary Care Network
(PCN); Custody Medical Care
Program; Children with Special
Health Care Needs (CSHCN);
Comprehensive Health
Insurance Pool (HIPUtah); Health
Insurance Continuation
Program; Utah’s Premium
Partnership for Health Insurance
(UPP)
HIS-501(C) (9-1-2010)
Page 71
Draft 4 (10-18-2010)
CARD F14-VT
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
VERMONT
Medicaid: Medicaid; Primary Care Plus
CHIP: Dr. Dynasaur
State/Other: Vermont Health Access Plan
(VHAP); HIV Insurance
Continuation Program (ICAP);
Children with Special Health
Needs (CSHN); Catamount
Health (Premium Assistance
Program)
HIS-501(C) (9-1-2010)
Page 72
Draft 4 (10-18-2010)
CARD F14-VA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
VIRGINIA
Medicaid: Medicaid; Virginia Medallion;
Medallion II
CHIP: Family Access to Medical Insurance
Security Plan (FAMIS); FAMIS Select
State/Other: State and Local Hospitalization
(SLH) Program; Care Connection
for Children; Children with
Special Health Care Needs
(CSHCN)
HIS-501(C) (9-1-2010)
Page 73
Draft 4 (10-18-2010)
CARD F14-WA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
WASHINGTON
Medicaid: Apple Health for Kids; Family
Medicaid; Healthy Options; Basic
Health Plus
CHIP: Apple Health for Kids with premium
State/Other: Basic Health; Children with
Special Health Care Needs
(CSHCN); Washington State
Health Insurance Pool; General
Assistance Unemployable
(GA-U); Healthcare for Workers
with Disabilities (HWD)
HIS-501(C) (9-1-2010)
Page 74
Draft 4 (10-18-2010)
CARD F14-WV
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
WEST VIRGINIA
Medicaid: Medical Assistance; Mountain
Health Trust (MHT); Mountain
Health Choices; Physician Assured
Access System (PAAS)
CHIP: Children’s Health Insurance Program
(CHIP); WVCHIP
State/Other: Children with Special Health
Care Needs; Health Insurance
Premium Payment Program
(HIPP); West Virginia Health
Insurance Plan
HIS-501(C) (9-1-2010)
Page 75
Draft 4 (10-18-2010)
CARD F14-WI
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
WISCONSIN
Medicaid: Medical Assistance MA; Wisconsin
Medicaid; Healthy Start; Forward
Health
CHIP: BadgerCare
State/Other: Health Insurance Risk Sharing
Program (HIRSP); Wisconsin
AIDS/HIV Health Insurance
Premium Subsidy Program;
Children with Special Health
Needs (CSHN); Children and
Youth with Special Health Care
Needs (CYSHCN)
HIS-501(C) (9-1-2010)
Page 76
Draft 4 (10-18-2010)
CARD F14-WY
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Some Medicaid programs are called
"Medical Assistance Program," "Title 19" or
"{State} Medicaid," such as "Alabama Medicaid."
CHIP or S-CHIP programs can also be under "Title
XXI Program" or "{State} CHIP," such as
"Pennsylvania CHIP." The names provided below
offer additional names for the public health
insurance programs for each state.
WYOMING
Medicaid: Wyoming Medicaid; EqualityCare
CHIP: Wyoming Kid Care
State/Other: Wyoming Health Insurance Pool
(WHIP); Children’s Special
Health Services (CSH); Caring
Program for Children
HIS-501(C) (9-1-2010)
Page 77
Draft 4 (10-18-2010)
HIS-501(C) (9-1-2010)
Page 78
Draft 4 (10-18-2010)
CARD F15
You may choose more than one.
1. Accidents
2. AIDS care
3. Cancer treatment
4. Catastrophic care
5. Dental care
7. Hospice care
8. Hospitalization only
9. Long-term care (nursing home care)
10. Prescriptions
11. Vision care
12. Other (specify)
HIS-501(C) (9-1-2010)
Page 79
Card F15
6. Disability insurance (cash payments
when unable to work for health reasons)
Draft 4 (10-18-2010)
CARD F16
1. Through employer
2. Through union
3. Through workplace, but don’t know if
employer or union
4. Through workplace, self-employed or
professional association
5. Purchased directly
6. Through a state/local government or
community program
7. Other (specify)
HIS-501(C) (9-1-2010)
Page 80
Draft 4 (10-18-2010)
CARD F17
1. 6 months or less
2. More than 6 months, but not more than
1 year ago
3. More than 1 year, but not more than 3
years ago
4. More than 3 years
5. Never
Card F16
Card F17
HIS-501(C) (9-1-2010)
Page 81
Draft 4 (10-18-2010)
CARD F18
You may choose up to five.
1. Person in family with health
insurance lost job or changed
employers
2. Got divorced or separated/death
of spouse or parent
3. Became ineligible because of
age/left school
4. Employer does not offer
coverage/or not eligible for
coverage
5. Cost is too high
6. Insurance company refused
coverage
7. Medicaid/Medical plan stopped
after pregnancy
8. Lost Medicaid/Medical plan
because of new job or increase
in income
9. Lost Medicaid (Other reason for
losing Medicaid)
10. Other (specify)
HIS-501(C) (9-1-2010)
Page 82
Draft 4 (10-18-2010)
CARD F19
0. Zero
1. Less than $500
2. $500 – $1,999
3. $2,000 – $2,999
4. $3,000 – $4,999
5. $5,000 or more
Card F18
Card F19
HIS-501(C) (9-1-2010)
Page 83
Draft 4 (10-18-2010)
CARD F20
1. Yes, born in one of the 50
United States or the District of
Columbia
2. Yes, born in Puerto Rico,
Guam, American Virgin
Islands, or other U.S. territory
3. Yes, born abroad to American
parent(s)
4. Yes, U.S. citizen by
naturalization
5. No, not a citizen of the United
States
HIS-501(C) (9-1-2010)
Page 84
Draft 4 (10-18-2010)
0.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Never attended/kindergarten only
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade, no diploma
GED or equivalent
HIGH SCHOOL GRADUATE
Some college, no degree
Associate’s degree: occupational,
technical, or vocational program
Associate’s degree: academic program
Bachelor’s degree (Example: BA, AB, BS,
BBA)
Master’s degree (Example: MA, MS,
MEng, MEd, MBA)
Professional School degree (Example:
MD, DDS, DVM, JD)
Doctoral degree (Example: PhD, EdD)
HIS-501(C) (9-1-2010)
Page 85
Card F20
Card F21
CARD F21
Draft 4 (10-18-2010)
CARD F22
1. Working for pay at a job or business
2. With a job or business but not at work
3. Looking for work
4. Working, but not for pay, at a
family-owned job or business
5. Not working at a job or business and
not looking for work
HIS-501(C) (9-1-2010)
Page 86
Draft 4 (10-18-2010)
CARD C1
1. Parent (Biological, adoptive, or step)
2. Grandparent
3. Aunt/Uncle
Card F22
Card C1
4. Brother/Sister
5. Other relative
6. Legal guardian
7. Foster parent
8. Other non-relative
HIS-501(C) (9-1-2010)
Page 87
Draft 4 (10-18-2010)
CARD C2
You may choose more than one.
1. Down syndrome
2. Cerebral palsy
3. Muscular dystrophy
4. Cystic fibrosis
5. Sickle cell anemia
6. Autism/Autism spectrum disorder
7. Diabetes
8. Arthritis
9. Congenital heart disease
10. Other heart condition
HIS-501(C) (9-1-2010)
Page 88
Draft 4 (10-18-2010)
CARD C3
0. Not true
1. Sometimes true
2. Often true
Card C2
Card C3
HIS-501(C) (9-1-2010)
Page 89
Draft 4 (10-18-2010)
CARD C4
0. Never
1. 6 months or less
2. More than 6 months, but
not more than 1 year ago
3. More than 1 year, but not
more than 2 years ago
4. More than 2 years, but not
more than 5 years ago
5. More than 5 years ago
HIS-501(C) (11-17-2009)
Page 90
Draft 4 (10-18-2010)
CARD C5
0. None
1. 1
2. 2 – 3
3. 4 – 5
4. 6 – 7
5. 8 – 9
6. 10 – 12
7. 13 – 15
8. 16 or more
Card C4
Card C5
HIS-501(C) (9-1-2010)
Page 91
Draft 4 (10-18-2010)
CARD C6
1. 1
2. 2 – 3
3. 4 – 5
4. 6 – 7
5. 8 – 9
6. 10 – 12
7. 13 – 15
8. 16 or more
HIS-501(C) (9-1-2010)
Page 92
Draft 4 (10-18-2010)
CARD C7
1. Not true
2. Somewhat true
3. Certainly true
Card C6
Card C7
HIS-501(C) (9-1-2010)
Page 93
Draft 4 (10-18-2010)
CARD C8
Overall, do you think that this child
has difficulties in any of the
following areas: emotions,
concentration, behavior, or being
able to get along with other people?
1. No
2. Yes, minor difficulties
3. Yes, definite difficulties
4. Yes, severe difficulties
HIS-501(C) (9-1-2010)
Page 94
Draft 4 (10-18-2010)
1. Pediatrician or family doctor
2. Psychiatrist, psychologist, clinical social
worker or psychiatric nurse
3. Speech, occupational or physical therapist
4. Religious or spiritual counselor or
advisor
5. Probation or juvenile corrections officer
or court counselor
6. Other
HIS-501(C) (9-1-2010)
Page 95
Card C8
Card C9
CARD C9
You may choose more than one.
Draft 4 (10-18-2010)
CARD A1
1. Working for pay at a job or business
2. With a job or business but not at work
3. Looking for work
4. Working, but not for pay, at a
family-owned job or business
5. Not working at a job or business and
not looking for work
HIS-501(C) (9-1-2010)
Page 96
Draft 4 (10-18-2010)
CARD A2
1. An employee of a PRIVATE company,
business, or individual for wages,
salary, or commission
2. A FEDERAL government employee
4. A LOCAL government employee
5. Self-employed in OWN business,
professional practice or farm
6. Working WITHOUT PAY in
family-owned business or farm
HIS-501(C) (9-1-2010)
Page 97
Card A1
Card A2
3. A STATE government employee
Draft 4 (10-18-2010)
CARD A3
1. 1–9 employees
2. 10–24 employees
3. 25–49 employees
4. 50–99 employees
5. 100–249 employees
6. 250–499 employees
7. 500–999 employees
8. 1000 employees or more
HIS-501(C) (9-1-2010)
Page 98
Draft 4 (10-18-2010)
CARD A4
You may choose more than one.
Card A3
Card A4
HIS-501(C) (9-1-2010)
Page 99
Draft 4 (10-18-2010)
CARD A5
1. ALL of the time
2. MOST of the time
3. SOME of the time
4. A LITTLE of the time
5. NONE of the time
HIS-501(C) (9-1-2010)
Page 100
Draft 4 (10-18-2010)
CARD A6
0. Not at all difficult
1. Only a little difficult
2. Somewhat difficult
3. Very difficult
4. Can’t do at all
6. Do not do this activity
Card A5
Card A6
HIS-501(C) (9-1-2010)
Page 101
Draft 4 (10-18-2010)
CARD A7
You may choose more than one.
1. Vision/problem seeing
2. Hearing problem
3. Arthritis/rheumatism
4. Back or neck problem
5. Fracture or bone/joint injury
6. Other injury
7. Heart problem
8. Stroke problem
9. Hypertension/high blood pressure
10. Diabetes
11. Lung/breathing problem (for
example, asthma and emphysema)
12. Cancer
13. Birth defect
14. Intellectual disability, also known
as mental retardation
15. Other developmental problem (for
example, cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
HIS-501(C) (9-1-2010)
Page 102
Draft 4 (10-18-2010)
CARD A8
0. Never
1. 6 months or less
2. More than 6 months, but not more than
1 year ago
3. More than 1 year, but not more than 2
years ago
4. More than 2 years, but not more than 5
years ago
5. More than 5 years ago
Card A7
Card A8
HIS-501(C) (9-1-2010)
Page 103
Draft 4 (10-18-2010)
CARD A9
0. None
1. 1
2. 2 – 3
3. 4 – 5
4. 6 – 7
5. 8 – 9
6. 10 – 12
7. 13 – 15
8. 16 or more
HIS-501(C) (9-1-2010)
Page 104
Draft 4 (10-18-2010)
1. 1
2. 2 – 3
3. 4 – 5
4. 6 – 7
5. 8 – 9
6. 10 – 12
7. 13 – 15
8. 16 or more
HIS-501(C) (9-1-2010)
Page 105
Card A9
Card A10
CARD A10
Draft 4 (10-18-2010)
HIS-501(C) (9-1-2010)
Page 106
Draft 4 (10-18-2010)
EXPLANATION OF THE NATIONAL HEALTH
INTERVIEW SURVEY (SPANISH)
EXPLICACIÓN DE LA ENCUESTA NACIONAL
DE ENTREVISTAS SOBRE LA SALUD
El propósito de la Encuesta Nacional de Entrevistas sobre la Salud (NHIS, siglas en inglés), es
obtener información de la frecuencia y severidad de varias enfermedades, incapacidades y
accidentes, el tipo de cuidado y tratamiento que la gente recibe para sus problemas de salud y
otra información relacionada a la salud de nuestra nación.
La Oficina del Censo de los Estados Unidos lleva a cabo esta encuesta para el Centro Nacional
de Estadísticas de la Salud el cual forma parte del Servicio de Salud Pública de los Estados
Unidos. Se está realizando esta encuesta para satisfacer la necesidad urgente de mantener al
día la estadísticas sobre la salud general. Esta encuesta está autorizada por la sección 242k
del título 42 del código de los Estados Unidos. Toda la información obtenida es confidencial y es
usada solo para propósitos estadísticos. Su participación en esta encuesta es voluntaria y no se
impone sanción alguna si decide no contestar a ciertas preguntas. Sin embargo, agradecemos su
cooperación, dado que ésta es extremadamente importante para asegurar que los datos obtenidos
sean exactos y completos.
SUGGESTED INTRODUCTION (SPANISH)
(Show your official Census Bureau I.D. and introduce yourself) "Soy __________ de la Oficina
del Censo de los Estados Unidos. Aquí le presento mi identificacíon.
Estamos llevando a cabo una encuesta sobre la salud para el Centro de Control y
Prevención de Enfermedades (CDC, siglas en inglés)." (Hand the respondent a copy
of the Advance Letter, HIS-600). "Quizá usted recuerda haber recibido esta carta hace
algunos días. Por favor tome su tiempo y lea esta información importante." (Allow
time for him or her to read the letter. If necessary, or if the respondent requests, read the
letter to him or her.) "¿Tiene usted alguna pregunta acerca de la Encuesta Nacional
de Entrevistas sobre la Salud?" (Answer any questions) "¿Está usted dispuesto a
participar en la encuesta?"
For each new respondent, use the following introduction:
"Soy __________ de la Oficina del Censo de los Estados Unidos. Aquí le presento
mi identificacíon. Estamos llevando a cabo una encuesta sobre la salud para el
Centro de Control y Prevención de Enfermedades (CDC, siglas en inglés).
Tengo alguna información provista por (previous respondent). Ahora, quisiera
hacerle a usted algunas preguntas."
TELEPHONE CALLBACK INTRODUCTION (SPANISH)
"Soy __________ de la Oficina del Censo de los Estados Unidos. Estamos llevando a
cabo una encuesta sobre la salud para el Centro de Control y Prevención de
Enfermedades (CDC, siglas en inglés). Yo había hecho arreglos con
(previous respondent) durante una visita a su hogar acerca de esta encuesta de salud.
Yo quedé con (previous respondent) en llamar hoy para hacerle a usted algunas
preguntas. Su hogar recibió previamente una carta explicando esta encuesta de
salud." (Note: If you are conducting a telephone follow-up with a new respondent, you must read
the Advance Letter.) "Su participación es voluntaria y usted puede terminar su
participación en cualquier momento. Conforme a la ley, la Oficina del Censo de
los Estados Unidos, CDC, y otras agencias de salud tienen que mantener todas
sus contestaciones confidenciales. Los datos son usados únicamente para
investigación en asuntos relacionados a la salud."
HIS-501(C) (9-1-2010)
Page 107
Introduction (Spanish)
La información es recopilada para la utilización por los departamentos gubernamentales de salud al
nivel federal, estatal y local, las escuelas de medicina, los institutos de investigación científica y
otros grupos e individuos.
Draft 4 (10-18-2010)
EXPLANATION OF THE
NATIONAL HEALTH INTERVIEW SURVEY
The basic purpose of the National Health Interview Survey (NHIS) is to obtain information about the
frequency and severity of various illnesses, disability, and accidents, the kind of care and treatment
people receive for their health problems, and other information related to the health of our Nation.
Data are compiled for use by Federal, State, and local health departments, medical schools,
research organizations, and other groups or individuals.
The U.S. Census Bureau is conducting this survey for the National Center for Health Statistics
which is part of the U.S. Public Health Service because of the urgent need for up-to-date
statistics on the health of the people. The survey is authorized by title 42, United States Code,
section 242k. The information collected is confidential and will be used only for
statistical purposes. Participation in this survey is voluntary and there are no penalties
for refusing to answer any question. However, your cooperation is extremely important in
obtaining much needed information to ensure the completeness and accuracy of the data.
SUGGESTED INTRODUCTION
(Show your official Census Bureau I.D. and introduce yourself) "I am __________ from the
U.S. Census Bureau. Here is my identification card. We are conducting the
National Health Interview Survey for the Centers for Disease Control and
Prevention (CDC)." (Hand the respondent a copy of the Advance Letter, HIS-600) "You may
remember receiving this letter a few days ago. Please take some time to read
this important information." (Allow time for him or her to read the letter. If necessary, or if the
respondent requests, read the letter to him or her.) "Do you have any questions about the
National Health Interview Survey?" (Answer any questions) "Are you willing to
participate in the survey?"
For each new respondent, use the following introduction:
"I am __________ from the U.S. Census Bureau. Here is my identification card.
We are conducting the National Health Interview Survey for the Centers for
Disease Control and Prevention (CDC). I have some information from (previous
respondent). Now, I would like to ask you some questions."
TELEPHONE CALLBACK INTRODUCTION
"I am __________ from the U.S. Census Bureau. We are conducting the National
Health Interview Survey for the Centers for Disease Control and Prevention (CDC).
I spoke with (previous respondent) during a visit to your household concerning this
health survey. I arranged with (previous respondent) to call today to ask you some
questions. Your household was previously provided with a letter explaining this
health survey." (Note: If you are conducting a telephone follow-up with a new respondent, you
must read the Advance Letter.) "Your participation is voluntary and you may
discontinue participation at any time. By law, the U.S. Census Bureau, the CDC,
and other health agencies must keep all your answers confidential. The data are
used only for statistical research on issues related to health."
HIS-501(C) (9-1-2010)
Page 108
Draft 4 (10-18-2010)
Adding NHIS Extra Units to Case Management
Usually EXTRA units are picked up by the instrument when you ask the housing unit
coverage questions at the beginning of the interview. EXTRA units picked up by the
instrument are automatically added to Case Management.
However, when you discover EXTRA units after you have completed the coverage
questions, you need to add these EXTRA units to Case Management yourself.
First determine if a unit is an EXTRA unit by using this criteria:
In general, an EXTRA unit is any separate housing unit that is not listed.
Permit Segments
The EXTRA unit must be:
– A separate living quarters
(live separately with
direct access to the unit)
– Within the same structure
– Within the same space occupied
by the original sample unit
Group Quarters in Area Segments
Group Quarters (GQ) do not have separate living quarters, therefore, there are no
EXTRA units for a GQ by definition. If you find more GQ units than expected as you
interview, note this in the F7 notes within the case. Do not enter any address data in
the F7 notes.
Then add the EXTRA unit(s) to Case Management following these
steps:
If you find more than 16 EXTRA units, call your office before conducting the interview
at the original sample unit.
1. Go to the Case List Screen.
2. Place the cursor on the parent unit address on the Case List Screen.
3. Click "Actions" on the Menu Bar and click "Add Case" to create new record for
the EXTRA unit(s).
4. Enter the unique unit designation or correct the address for the EXTRA unit.
HIS-501(C) (9-1-2010)
Page 109
Introduction (English)
Adding Extra Units
Area Segments
The EXTRA unit must be:
– A separate living quarters
(live separately with
direct access to the unit)
– Within the same structure or on the
same property as the sample unit
Draft 4 (10-18-2010)
NATIONAL HEALTH INTERVIEW SURVEY
OUTCOME CODES
OUTCOME
USUAL
ACTION LAPTOP
DEFINITION
CAPI
CONTROL
200
201
202
203
204
205
New case, not started
Complete interview
Accessed instrument, no progress
Sufficient partial interview, no follow-up
Insufficient partial interview, follow-up needed
Sufficient partial interview, follow-up needed
00
10
01
04
05
05
Remain
Transmit
Remain
Transmit
Remain
Remain
NA
To DSD
NA
To DSD
NA
NA
213
215
216
217
218
219
220
Type A
Language problem
Insufficient partial
No one home, repeated calls
Temporarily absent, no follow-up
Refused
Other Type A
Temporarily absent, follow-up possible
21
21
21
21
21
21
01
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Remain
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
NA
223
224
225
226
228
229
230
231
232
233
235
236
Type B
Occupied entirely by Armed Forces members
Occupied entirely by minors
Occupied entirely by persons with URE
Vacant, nonseasonal
Unfit or to be demolished
Under construction, not ready
Converted to temporary business or storage
Unoccupied site for mobile home, trailer, or tent
Permit granted, construction not started
Other Type B
Vacant, seasonal
Occupied – screened out by household
31
31
31
31
31
31
31
31
31
31
31
31
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
240
241
242
243
244
245
246
247
248
256
257
290
Type C
Demolished
House or trailer moved
Outside segment boundaries
Converted to permanent business or storage
Merged
Condemned
Built after April 1st 2000 (4/1/2000)
Unused line of listing sheet
Other Type C
Removed during subsampling
Unit already had a chance of selection
Spawned in error
41
41
41
41
41
41
41
41
41
41
41
41
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
Transmit
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
To Supervisor
ACTION
CODES
00
01
04
05
10
21
31
41
DESCRIPTION
Case not started
Case open, insufficient data
Partial interview, no follow-up
Partial but not sufficient
Complete interview
Type A noninterview
Type B noninterview
Type C noninterview
HIS-501(C) (9-1-2010)
Page 110
Draft 4 (10-18-2010)
Outcome Codes
Instrument Flowchart
HIS-501(C) (9-1-2010)
Page 111
Draft 4 (10-18-2010)
2011 NHIS CHECKLIST FOR INTERVIEWING
Laptop Accessories
Batteries, charged
Power cord
Extension cord
3-prong plug
Advance Letters*
English – HIS-600(L)
Spanish – HIS-600(L)(SP)
Thank You Letters
English – HIS-601(L)
Spanish – HIS-601(L)(SP)
Flashcard Booklet*
English – HIS-501(C)
Spanish – HIS-501(C)(SP)
Calendar Card* – HIS-505
Pen
FR Manual* – HIS-100C
*Throw away old versions
HIS-501(C) (9-1-2010)
Page 112
Draft 4 (10-18-2010)
Page 113
2011 NHIS Checklist
HIS-501(C) (9-1-2010)
| File Type | application/pdf |
| File Title | untitled |
| File Modified | 2010-12-03 |
| File Created | 2010-10-14 |