Document
Staff for Enrollment Data Collection
ICR 201204-0990-004 · OMB 0990-0400 · Object 33534101.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | Staff for Enrollment Data Collection |
| Author | Sean Orzol |
| Last Modified By | Calc |
| File Modified | 2012-07-13 |
| File Created | 2026-10-04 |
| Conversion State | complete |
Extracted Text
Table 1.X: New [Medicaid/CHIP] Enrollees by Month, [Simplified/Traditional Enrollment Procedures] START 12-Months presimplified enrollment procedure Month 1 Number New Enrollees By Subgroup Demographic Characteristics Age of Child at start of Month Younger than 1 1-5 6-12 13-18 19-21 Unknown Race/Ethnicity Hispanic Non-Hispanic American Indian and Non-Hispanic Alaska Native Non-Hispanic Asian, Non-Hispanic Native Hawaiian and Other Pacific Islander Non-Hispanic Black Non-Hispanic White Other Unknown Gender Female Male Unknown/ other Primary Language English Spanish Other non-English Unknown US Citizenship Citizen Qualified non-citizen Non-qualified non-citizen Awaiting confirmation Other Unknown Household Income by FPL <100% 100 - <133 133-<185 185-<200 200- <300 300+ Unknown Residence Urban Rural Unknown Family Size 2 3 4 5 6 or more Unknown Number of Children in household 1 2 3 4 or more Unknown Number with a TANF Flag Number with Parent/Caregiver employment Private Insurance Coverage Number with Third Party Coverage Number with coverage available from employer (if available) Number with a recent loss of private coverage (if available) Prior Public Coverage Number with a previous spell of public coverage, past 3-months Number with a previous spell of public coverage, past 6-months Number with a previous spell of public coverage, past 12 months ELE = Express Lane Eligibility; FPL = federal poverty level; TANF = Temporary Assistance for Needy Families. ment Procedures] Simplified enrollment procedure implementation Month 2… …Month 13 END Month 14 Month 15 Month 16+ (as needed) Dec 20122 Table 2.X: New [Medicaid/CHIP] Enrollees Retention Measures, [Simplified/Traditional Enrollment Procedures] START 12-Months presimplified enrollment procedure Month 1 Month 2… Number New Enrollees Likelihood of retention Number still enrolled 6 months from enrollment Number still enrolled 12 months from enrollment Number still enrolled 13 months from enrollment Number still enrolled 18 months from enrollment Number still enrolled 24 months from enrollment Disenrollment/Reenrollment Measures Number disenrolled (within 6 months) Number disenrolled (within 12 months) Number disenrolled (within 13 months) Number disenrolled (within 18 months) Number disenrolled (within 24 months) Number of disenrollees within 13 months that reenrolled within 3 months Number of disenrollees within 13 months that reenrolled within 6 months Number of disenrollees within 13 months that reenrolled within 12 months Number of disenrollees within 13 months that reenrolled within 3 months via simplified enrollment procedure Number of disenrollees within 13 months that reenrolled within 6 months via simplified enrollment procedure Number of disenrollees within 13 months that reenrolled within 12 months via simplified enrollment procedure Transfers Number of enrollees that transferred to [CHIP/Medicaid] within 6 months Number of enrollees that transferred to [CHIP/Medicaid] within 12 months Number of enrollees that transferred to [CHIP/Medicaid] within 13 months Number of enrollees that transferred to [CHIP/Medicaid] within 18 months Number of enrollees that transferred to [CHIP/Medicaid] within 24 months Number of enrollees that transferred to [CHIP/Medicaid] within 6 months via simplified enrollment procedure Number of enrollees that transferred to [CHIP/Medicaid] within 12 months via simplified enrollment procedure Number of enrollees that transferred to [CHIP/Medicaid] within 13 months via simplified enrollment procedure Number of enrollees that transferred to [CHIP/Medicaid] within 18 months via simplified enrollment procedure Number of enrollees that transferred to [CHIP/Medicaid] within 24 months via simplified enrollment procedure CHIP = Children's Health Insurance Program; ELE = Express Lane Eligibility Simplified enrollment procedure implementation …Month 13 END Month 14 Month 15 Month 16+ (as needed) Dec 20122