CMS-10615 Debriefing Script - Disenrolelee Lockout Survey

OMB Control Number: 0938-1300
PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0938-1300. The time required to complete this
information collection is estimated to average 60 minutes per response, including the time to
review instructions, search existing data resources, gather the data needed, and complete and
review the information collection. If you have comments concerning the accuracy of the time
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21244-1850. Please do not send applications, claims, payments, medical records or any
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forwarded, or retained. If you have questions or concerns regarding where to submit your
documents, please contact Teresa DeCaro, [email protected].

DEBRIEFING SCRIPT – DISENROLLEES & LOCKOUTS

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OMB Control Number: 0938-1300

Healthy Indiana Plan (HIP) 2.0
Disenrollee and Lockout Survey Testing Debriefing Script
Survey Background
Part of the federal evaluation of the Healthy Indiana Plan (HIP) 2.0 Demonstration will be based on
information collected using three beneficiary survey instruments. The three target populations for the
instruments include: (1) current HIP 2.0 beneficiaries; (2) newly enrolled HIP 2.0 beneficiaries; and (3)
HIP 2.0 disenrollees and beneficiaries who have been “locked out.” All instruments contain survey
questions from existing beneficiary questionnaires, survey questions adapted from existing beneficiary
questionnaires, and newly developed survey questions. The newly developed survey questions are
especially important for testing, and focus on specific policies of interest to CMS. The beneficiary
feedback captured by these instruments will help inform CMS decision making on health care policies.
The HIP 2.0 disenrollees and beneficiaries who have been ‘locked out’ include three subpopulations –
disenrollees, HIP Basic enrolled but formerly HIP Plus enrolled beneficiaries, individuals who have been
locked out of HIP 2.0. These subpopulations are identified by their poverty level. The consequences of
failing to make a monthly contribution to their POWER account vary. Those failing to make a monthly
contribution above 100% FPL are locked out of HIP 2.0 and those failing to make a monthly contribution
at or below 100% FPL are moved from HIP Plus to HIP Basic.
This survey testing script serves as a guide for the interviewer debriefing on the HIP 2.0 Disenrollee
and Lockout Beneficiary Survey.
Pretest Introduction [Interviewer reads]
On behalf of the Centers for Medicare & Medicaid Services and Social and Scientific Systems, Inc.,
thank you for agreeing to participate in this study of the Healthy Indiana Plan 2.0 (HIP 2.0). Your
comments and opinions are very important to us.
The purpose of this interview is not to collect data, but to test a questionnaire. The questionnaire we are
testing will be provided to Hoosiers as a paper questionnaire and an online (Web) questionnaire. Some of
the questions we will review today may be difficult to understand, hard to answer, or can be understood in
different ways. I am more interested in what you were thinking when you answered these questions than
your actual answers. I would like to know your experience with deciding how to answer certain questions.
We expect that some of questions will not be perfect, and that is what you will be helping us identify
today. Do you have any questions about what I just told you?
After you complete the questionnaire, I will go through it with you and sometimes ask what you think
about a question or what a particular word means to you. We will not go through every question. Please
feel free to give me any other comments you might have at the end of the interview.
Your comments will be kept private. Please answer the questions as freely as you can. You may refuse to
answer any question that you do not wish to answer. This interview should take no more than 45 minutes
of your time.
Do you have any questions?

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OMB Control Number: 0938-1300
OK, let’s begin. Please feel free to use your questionnaire to help you answer my questions.

General Interviewer Probes
[Interviewer Instructions: The following questions are general probes that interviewers may
use during the debriefing.]
•
•
•
•
•
•
•

Could you please tell me more about that?
Was that easy or hard to answer?
How did you decide on that answer?
How confident are you in your answer?
Were any of the answer choices not clear, or confusing?
I noticed that you hesitated – please tell me what you were thinking.
Were there any questions that were asked that did not seem to belong in this questionnaire?

Overarching/General Beneficiary Survey Interview Questions
INTERVIEWER: How easy or difficult was it to for you to understand the purpose of the survey?
INTERVIEWER: Based on your experience with the survey, how likely would you be to complete the
actual paper mail in survey if you were selected to participate? Why/Why not?
INTERVIEWER: Were the time period references difficult to follow?
PROBE: Was it hard to recall and think about “After you were no longer enrolled in HIP 2.0?”
PROBE: Was it hard to recall and think about “While you were in HIP 2.0?”

Survey Section: About Your HIP 2.0 Enrollment
Question #: 1
INTERVIEWER: What does the word “enrolled” mean to you? How did you interpret it?
INTERVIEWER: Have you heard of the word “lockout?”
If “Yes”  Please tell me about your understanding of what “lockout” means.
If “Yes”  Do you interpret being “locked out” as the same or different from being
“disenrolled” from HIP?
INTERVIEWER: What did you select as your answer for Question 1?

[Interviewer Instructions: If respondent indicates an “A” answer option skip to PAGE 5 for
beginning the interview and start with the HIP Basic Enrolled, Formerly HIP Plus Enrolled
questions. All other responses, proceed with interview protocol]
Survey Section: About Your HIP 2.0 Enrollment
DEBRIEFING SCRIPT – DISENROLLEES & LOCKOUTS

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OMB Control Number: 0938-1300
Question #: 6
INTERVIEWER: At what point did you consider yourself no longer enrolled in HIP?
PROBE: Do you consider being “locked out” as being no longer enrolled in HIP?
Question #: 7
INTERVIEWER: What did the word “cost” mean to you?
Question #: 8
INTERVIEWER: Did the examples for preventive care make sense to you or not?
INTERVIEWER: Are there any other preventive care examples you think we should include?
INTERVIEWER: What do you usually think of as preventive care? Could you give us some examples?
INTERVIEWER: Did you think about health care from only your doctor, or did you include other types
of health care providers?
INTERVIEWER: Is there any other answer choice you think should be included?
INTERVIEWER: Please look at answer “J”, “dental care and vision (eye) care.” Do you usually think of
costs for these services as separate costs, or do you think of them as combined costs?
PROBE: Would you be able to split out your costs for dental and eye care, or not?
Question #: 9 and 10
INTERVIEWER: When you read question 9, did you think of “not paying for” transportation and “not
getting” transportation as the same idea or two different ideas?
INTERVIEWER: Was this question easy or hard to answer?
INTERVIEWER: How confident are you with your answer?
Question #: 11
INTERVIEWER: What does “monthly or annual contribution” mean to you?
INTERVIEWER: What did the word “paperwork” mean to you?
Question #: 12
INTERVIEWER: What does “reenroll” mean to you?
Question #: 13
INTERVIEWER: Did you feel that this question had a negative, positive, or neutral tone?
PROBE: Were any of the answer options unclear or confusing?

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OMB Control Number: 0938-1300
PROBE: Any missing answer options?

Survey Section: POWER accounts and monthly or annual contributions
INTERVIEWER: Please think about the questions in the POWER account section and how you
answered them.
INTERVIEWER: What length of time or time period did you think of when answering the questions?
INTERVIEWER: Did the words “monthly or annually” make the questions clearer or more confusing?
Why?
Question #: 16
INTERVIEWER: In question 16, answer “C”, did the word “part” make the question clearer or more
confusing? Why?
Question #: 20
INTERVIEWER: In question 20, please tell me in your own words what answer “B” means. What does
answer “C” mean?
Question #: 21
INTERVIEWER: What did “use your POWER account” mean to you?
PROBE: What actions were you thinking about for using your POWER account?
Question #: 24
INTERVIEWER: Was this question easy or hard to answer? Why?
Question #: 25, 26, and 27
INTERVIEWER: Did you agree with the definition of “preventive services” or not? Were those
examples of what you usually think of as preventive care?
If “Not”  What did “preventive services” mean to you?
How easy or hard was it to think about the difference between “all” or “some” of your preventive
services?
INTERVIEWER: When you answered question 27, did you think about all of your preventive services,
or only some?
If “Some”  INTERVIEWER: Which ones?

Survey Section: Access
Question #: 29 and 30

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OMB Control Number: 0938-1300
INTERVIEWER: What length of time or time period did you think about when answering these
questions?

Survey Section: HIP Basic enrolled, formerly HIP Plus enrolled
INTERVIEWER: Please think about the questions in the HIP Basic enrolled, formerly HIP Plus
enrolled section and how you answered them.
INTERVIEWER: Did you think about your HIP Basic and HIP Plus coverage experiences together or
separately?
INTERVIEWER: How hard was it?
INTERVIEWER: Do you feel you were able to answer the questions about each of your experiences in
HIP Basic and HIP Plus?
PROBE: Did you think of your experience in HIP 2.0 as one time, or as two times?
Question #: 39
INTERVIEWER: In question 39, please tell me in your own words what answer “B” means. What does
answer “C” mean?
Question #: 40
INTERVIEWER: What did the word “cost” mean to you?
Question #: 41
INTERVIEWER: Did the examples listed in the preventive care answer choice make sense?
INTERVIEWER: If no: What do you usually think of as preventive care?
INTERVIEWER: Are there any other examples of preventive care that you think we should include?
INTERVIEWER: Did you think about health care from only your doctor, or did you include other types
of health care providers?
INTERVIEWER: Are there any other answer choices you think should be included?
INTERVIEWER: Please look at answer “J”, “dental care and vision (eye) care.” Do you usually think of
costs for these services as separate costs, or do you think of them as combined costs?
PROBE: Would you be able to split out your costs for dental and eye care, or not?
Question #: 42 and 43
INTERVIEWER: When you were answering question 42, did you think of “not paying for”
transportation and “not getting” transportation as the same idea or two different ideas?
INTERVIEWER: Was this question easy or hard to answer?

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OMB Control Number: 0938-1300
INTERVIEWER: How confident are you with your answer?

Survey Section: Demographics/About You
Question #: 55
INTERVIEWER: Was this question easy or hard to answer? Why?

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