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pdf2023 MCBS Facility Instrument
Variable Name
IN-Health Insurance
MR Screen Name Question Type
Question Text/Description
Code List
Routing
(01) CONSENT OBTAINED (CONTINUE INTERVIEW)
(02) FINAL CONSENT DENIED
(03) REFUSAL CONVERTED (CONTINUE INTERVIEW)
(04) FINAL REFUSAL
(01) IN1PRE2 - IN1PR2CT
(02) INEND - INENDCT
(03) IN1PRE2 - IN1PR2CT
(04) INEND - INENDCT
(01) CONTINUE
(02) CONSENT REQUIRED
(03) INITIAL REFUSAL
(01) BOX IN3
(02) INEND - INENDCT
(03) INEND - INENDCT
Has (SP) ever been covered by [READ NAME(S) FROM ABOVE]?
(00) NO
(01) YES
(02) PENDING
(-8) Don't Know
(-9) Refused
(00) IN13A - ICAREPTD
(01) IN5A-MCAIDHMO
(02) IN13A - ICAREPTD
(-8) IN13A - ICAREPTD
(-9) IN13A - ICAREPTD
yes/no
Is (SP) now covered by [READ NAME(S) FROM ABOVE]?
(00) NO
(01) YES
(02) PENDING
(-8) Don't Know
(-9) Refused
(00) IN18 - IGAPCOV
(01) IN5A-MCAIDHMO
(02) IN18 - IGAPCOV
(-8) IN18 - IGAPCOV
(-9) IN18 - IGAPCOV
IN5A
yes/no
Some states now use HMOs (health maintenance organizations) to provide some or all health care for Medicaid
beneficiaries. (Is/Was) (SP) enrolled in a [READ NAME(S) FROM ABOVE] HMO?
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) BOX IN3A
(01) BOX IN3A
(-8) BOX IN3A
(-9) BOX IN3A
BOX IN3A
routing
IF THIS IS A BASELINE INTERVIEW, GO TO IN6 - ICDCRCOV.
ELSE GO TO IN18 - IGAPCOV.
yes/no
Was (SP) covered by [READ NAME(S) FROM ABOVE] [on September 1, (CURRENT YEAR)?/when (he/she) was
admitted on (FAD/RAD)?]
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) IN13A - ICAREPTD
(01) IN13A - ICAREPTD
(-8) IN13A - ICAREPTD
(-9) IN13A - ICAREPTD
HEALTH INSURANCE SECTION SPECIFICATIONS
CRITERIA
SAMPLE TYPE= CFR, CFC, FFC, FCF, IPR
SEASON
If SAMPLE_TYPE= CFR, then SEASON=FALL
If SAMPLE TYPE in (CFC, FFC, FCF), then SEASON= ALL
If SAMPLE TYPE= IPR, then SEASON= FALL
PLACEMENT
Administered in flexible order after FQ and RH sections are completed.
BOX INBEG
CONREFFN
INCONREF
routing
code one
IF INDISP = 1/ConsentRequired OR INDISP = 4/InitialRefusal, GO TO INCONREF - CONREFFN.
ELSE GO TO IN1PRE2 - IN1PR2CT.
PLEASE INDICATE THE FINAL (CONSENT/REFUAL) STATUS FOR THIS SECTION.
The following questions are about (SP's) health insurance.
IN1PR2CT
IN1PRE2
code one
BOX IN3
routing
IF THERE ARE NO CONSENT OR REFUSAL ISSUES FOR THIS SECTION, PRESS "1" TO CONTINUE.
IF THIS IS A BASELINE INTERVIEW GO TO IN1 - ICAIDECO.
ELSE IF THIS IS NOT A BASELINE INTERVIEW GO TO IN1A - ICAIDNOW.
ICAIDECO
ICAIDNOW
MCAIDHMO
ICDCRCOV
IN1
IN1A
IN6
yes/no
Page 1 of 3
2023 MCBS Facility Instrument
Variable Name
IN-Health Insurance
MR Screen Name Question Type
Question Text/Description
Code List
Routing
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) IN18 - IGAPCOV
(01) IN18 - IGAPCOV
(-8) IN18 - IGAPCOV
(-9) IN18 - IGAPCOV
(00) NO
On [September 1, (CURRENT YEAR)/(FAD/RAD)/DOD], was (SP) covered by private health insurance that pays for
(01) YES
some or all charges for inpatient and outpatient hospital and physician services and/or supplements Medicare
(-8) Don't Know
(Medigap policy)?
(-9) Refused
(00) IN 20-ILTCCOV
(01) IN19-IGAPNAME
(-8) IN20-ILTCCOV
(-9) IN20-ILTCCOV
Our records show that (SP) is covered by Medicare. I'd like to ask some questions about (his/her) Medicare
coverage.
ICAREPTD
IN13A
yes/no
Was (SP) covered by Part D of Medicare on [September 1, (CURRENT YEAR)/(FAD/RAD)/DOD]?
PRESS F1 FOR PART D DEFINITIONS.
IGAPCOV
IN18
yes/no
What is the name of the insurance company?
IGAPNAME
IN19
Text
[PROBE: Any others?]
IF NO MORE INSURANCE COMPANY NAMES, PRESS ENTER TO CONTINUE.
(01) Continuous Answer
(01) IN19 - IGAPNAM2
(01) Continuous Answer
(01) IN19 - IGAPNAM3
(01) Continuous Answer
(01) IN19 - IGAPNAM4
(01) Continuous Answer
(01) IN19 - IGAPNAM5
(01) Continuous Answer
(01) IN20 - ILTCCOV
What is the name of the insurance company?
IGAPNAM2
IN19
Text
[PROBE: Any others?]
IF NO MORE INSURANCE COMPANY NAMES, PRESS ENTER TO CONTINUE.
What is the name of the insurance company?
IGAPNAM3
IN19
Text
[PROBE: Any others?]
IF NO MORE INSURANCE COMPANY NAMES, PRESS ENTER TO CONTINUE.
What is the name of the insurance company?
IGAPNAM4
IN19
Text
[PROBE: Any others?]
IF NO MORE INSURANCE COMPANY NAMES, PRESS ENTER TO CONTINUE.
What is the name of the insurance company?
IGAPNAM5
IN19
Text
ILTCCOV
IN20
yes/no
ILTCNAME
IN21
Text
[PROBE: Any others?]
IF NO MORE INSURANCE COMPANY NAMES, PRESS ENTER TO CONTINUE.
(00) NO
On [September 1, (CURRENT YEAR)/(FAD/RAD)/DOD], was (SP) covered by private health insurance that pays for (01) YES
some or all charges for more than 100 days of nursing home care, that is, a long-term care policy?
(-8) Don't Know
(-9) Refused
(00) IN22 - ICHACOV
(01) IN21 - ILTCNAME
(-8) IN22 - ICHACOV
(-9) IN22 - ICHACOV
What is the name of the insurance company?
(01) Continuous Answer
(01) IN21 - ILTCNAM2
(01) Continuous Answer
(01) IN21 - ILTCNAM3
(01) Continuous Answer
(01) IN21 - ILTCNAM4
(01) Continuous Answer
(01) IN21 - ILTCNAM5
[PROBE: Any others?]
What is the name of the insurance company?
ILTCNAM2
IN21
Text
[PROBE: Any others?]
What is the name of the insurance company?
ILTCNAM3
IN21
Text
[PROBE: Any others?]
What is the name of the insurance company?
ILTCNAM4
IN21
Text
[PROBE: Any others?]
Page 2 of 3
2023 MCBS Facility Instrument
IN-Health Insurance
Variable Name
MR Screen Name Question Type
ILTCNAM5
IN21
Question Text/Description
Code List
Routing
(01) Continuous Answer
(01) IN22 - ICHACOV
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) IN23 - IDVACOV
(01) IN23 - IDVACOV
(-8) IN23 - IDVACOV
(-9) IN23 - IDVACOV
(00) NO
(01) YES
(-8) Don't Know
(-9) Refused
(00) IN24 - IPUBCOV
(01) IN24 - IPUBCOV
(-8) IN24 - IPUBCOV
(-9) IN24 - IPUBCOV
What is the name of the insurance company?
Text
[PROBE: Any others?]
ICHACOV
IN22
Yes/No
Was (SP) covered by either TRICARE or CHAMPVA for hospital or physician care on [September 1, (CURRENT
YEAR)/(FAD/RAD)/DOD]?
PRESS F1 FOR EXPLANATION OF TRICARE AND CHAMPVA.
IDVACOV
IN23
Yes/No
Was (SP) covered by any other Department of Veterans Affairs (VA) program or contract on [September 1,
(CURRENT YEAR)/(FAD/RAD)/DOD]?
(00) BOX IN9
(01) IN25 - IPUBNAME
(-8) BOX IN9
(-9) BOX IN9
(01) Continuous Answer
(01) BOX IN9
(01) INEND - INENDCT
(02) INEND - INENDCT
(03) INEND - INENDCT
(04) INEND - INENDCT
(05) INEND - INENDCT
(-8) INEND - INENDCT
(-9) INEND - INENDCT
(01) BOX INEND
IPUBCOV
IN24
Yes/No
(00) NO
(Besides [READ NAME(S) FROM ABOVE], was/Was) (SP) covered by any other public assistance health insurance (01) YES
program on [September 1, (CURRENT YEAR)/(FAD/RAD)/DOD]?
(-8) Don't Know
(-9) Refused
IPUBNAME
IN25
Text
What (is/was) the name of the public assistance health insurance program?
BOX IN9
routing
IF SP ALIVE, AND A CFR, FFC, OR FCF AND IS A FALL ROUND, GO TO INBQ13A - IMARSTAT.
ELSE GO TO INEND - INENDCT.
IMARSTAT
INBQ13A
code one
Is (SP) currently married, widowed, divorced, separated, or never married?
(01)NEVER MARRIED
(02) MARRIED
(03) WIDOWED
(04) DIVORCED
(05) SEPARATED
(-8) Don't Know
(-9) Refused
INENDCT
INEND
code one
YOU HAVE COMPLETED THE HEALTH INSURANCE SECTION FOR THIS SP.
PRESS "1" TO RETURN TO NAVIGATION SCREEN.
(01) CONTINUE
BOX INEND
routing
GO TO NAVIGATOR
Page 3 of 3
| File Type | application/pdf |
| File Title | Medicare Current Beneficiary Survey Section Specification for IN |
| Subject | Medicare beneficiaries, MCBS Facility instrument, 2023, Health Insurance, IN |
| Author | NORC |
| File Modified | 2023-05-19 |
| File Created | 2023-05-18 |