Flashcard Booklet

Attachment 3h Flashcard Booklet

HIS-501(C) (2014)

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

11-14-2013

U.S. DEPARTMENT
OF COMMERCE

NATIONAL
HEALTH
INTERVIEW
SURVEY

Economics and Statistics
Administration

U.S. CENSUS BUREAU

Field
Representative’s
Flashcard and
Information
Booklet

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) (11-14-2013)

Page 2

No
Yes

No
Yes
Yes
No

Type A Noninterviews
Type B Noninterviews
Type C Noninterviews
Partial Interviews
Classification of Living Quarters Problems
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

WHEN TO CONTACT YOUR FS OR
IMMEDIATE SUPERVISOR
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) (11-14-2013)

Page 3

Card HM
When to Fill F7 and
Contact Supervisor

WHEN TO FILL THE F7
CASE MANAGEMENT NOTES

2013
JANUARY
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 29 30 31

S M
1
7 8
14 15
21 22
28 29

S
5
12
19
26

AUGUST
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

FEBRUARY
S M T W T F 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
MARCH
S M T W T

1
8
15
22
29

S
2
9
16
23
30

F
5
12
19
26

S
6
13
20
27

MAY
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

F
3
10
17
24
31

S
4
11
18
25

JUNE
S M T W T

F

S
1
8
15
22
29

3 4 5 6 7
10 11 12 13 14
17 18 19 20 21
24 25 26 27 28
31
APRIL
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

F

2 3 4 5 6 7
9 10 11 12 13 14
16 17 18 19 20 21
23 24 25 26 27 28
30

F
5
12
19
26

S
6
13
20
27

F
2
9
16
23
30

S
3
10
17
24
31

SEPTEMBER
S M T W T F
1 2 3 4 5 6
8 9 10 11 12 13
15 16 17 18 19 20
22 23 24 25 26 27
29 30
OCTOBER
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

NOVEMBER
S M T W T F

S
1
8
15
22
29

Page 4

S
7
14
21
28

S
5
12
19
26

S

1
8
15
22
29

2
9
16
23
30

DECEMBER
M T W T F
2 3 4 5 6
9 10 11 12 13
16 17 18 19 20
23 24 25 26 27
30 31

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

Federal Holiday (observed)
HIS-501(C) (11-14-2013)

JULY
T W T
2 3 4
9 10 11
16 17 18
23 24 25
30 31

2014
JANUARY
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

JULY
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

S
4
11
18
25

2 3 4 5 6
9 10 11 12 13
16 17 18 19 20
23 24 25 26 27

S
1
7 8
14 15
21 22
28

MARCH
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

MAY
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
31

JUNE
T W T
3 4 5
10 11 12
17 18 19
24 25 26

F
6
13
20
27

S
7
14
21
28

2
9
16
23
30
S
6
13
20
27

S
1
8
15
22
29

3 4 5 6
10 11 12 13
17 18 19 20
24 25 26 27
31
APRIL
M T W T
1 2 3
7 8 9 10
14 15 16 17
21 22 23 24
28 29 30

M
2
9
16
23
30

AUGUST
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

S
2
9
16
23
30

SEPTEMBER
S M T W T F

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
OCTOBER
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
NOVEMBER
S M T W T F
2
9
16
23
30

Page 5

S
4
11
18
25

S

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

DECEMBER
S M T W T F
1 2 3 4 5
7 8 9 10 11 12
14 15 16 17 18 19
21 22 23 24 25 26
28 29 30 31

Federal Holiday (observed)
HIS-501(C) (11-14-2013)

S
5
12
19
26

S
6
13
20
27

Calendar – 2013
Calendar – 2014

FEBRUARY
S M T W T F

F
4
11
18
25

HIS-501(C) (11-14-2013)

Page 6

HOLIDAYS*
2013
New Year’s Day

January 1

Martin Luther King’s Birthday

January 21

President’s Day

February 18

Easter

March 31

Memorial Day

May 27

Independence Day

July 4

Labor Day

September 2

Columbus Day

October 14

Veteran’s Day

November 11

Thanksgiving

November 28

Christmas

December 25

Holidays – 2013 & 2014

2014
New Year’s Day

January 1, 2014

Martin Luther King’s Birthday

January 20

President’s Day

February 17

Easter

April 20

Memorial Day

May 26

Independence Day

July 4

Labor Day

September 1

Columbus Day

October 13

Veteran’s Day

November 11

Thanksgiving

November 27

Christmas

December 25

*Federal Holidays (observed), except Easter
HIS-501(C) (11-14-2013)

Page 7

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) (11-14-2013)

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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 or Chamorro
7. Samoan
8. Other Pacific Islander
9. Asian Indian
10. Chinese
11. Filipino

13. Korean
14. Vietnamese
15. Other Asian

HIS-501(C) (11-14-2013)

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Card H1
Card H2

12. Japanese

HIS-501(C) (11-14-2013)

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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) (11-14-2013)

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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) (11-14-2013)

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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) (11-14-2013)

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Card F1
Card F2

You may choose more than one.

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) (11-14-2013)

25

Page 14

26

27

28

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) (11-14-2013)

Page 15

Card F3
Card F4

Shoulder

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) (11-14-2013)

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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) (11-14-2013)

Page 17

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) (11-14-2013)

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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) (11-14-2013)

Page 19

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) (11-14-2013)

Page 20

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) (11-14-2013)

Page 21

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) (11-14-2013)

Page 22

You may choose more than one.
1. Private health insurance*
2. Medicare
3. Medi-Gap
4. Medicaid
5. SCHIP (CHIP/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) (11-14-2013)

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Card F11
Card F12

CARD F12

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) (11-14-2013)

S

SEX

MALE

EFFECTIVE DATE

(PART A) 07–01–1986
(PART B) 07–01–1986

Page 24

Card F13
Card F14 - All States

HIS-501(C) (11-14-2013)

Page 25

HIS-501(C) (11-14-2013)

Page 26

CARD F14-AL
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
ALABAMA
Medicaid: Patient 1st; SOBRA
CHIP: ALL KIDS
State/Other: Children’s Rehabilitation
Service (CRS); Alabama Health
Insurance Plan (AHIP)

HIS-501(C) (11-14-2013)

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CARD F14-AK
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by 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)

HIS-501(C) (11-14-2013)

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CARD F14-AZ
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
ARIZONA
Medicaid: AHCCCS; Arizona Health Care
Cost Containment System; Baby
Arizona; Healthy Arizona; SOBRA
CHIP: KidsCare
State/Other: KidsCare II; 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) (11-14-2013)

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CARD F14-AR
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
ARKANSAS
Medicaid: ConnectCare; Katie Beckett;
TEFRA; ARKids First A
CHIP: ARKids First B
State/Other: Children’s Medical Services
(CMS); HIFA Waiver Safety Net
Benefit Program

HIS-501(C) (11-14-2013)

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CARD F14-CA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by 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);
Healthy Kids Program

HIS-501(C) (11-14-2013)

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CARD F14-CO
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called,
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
COLORADO
Medicaid: Accountable Care Collaborative
(ACA); Primary Care Physician
Program (PCPP); Health Colorado
CHIP: Child Health Plan Plus (CHP+);
Children’s Basic Health Plan
State/Other: Health Care Program for
Children with Special Needs
(HCP); CoverColorado; Colorado
Indigent Care Program (CICP)

HIS-501(C) (11-14-2013)

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CARD F14-CT
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
CONNECTICUT
Medicaid: Medical Assistance Program;
HUSKY A; HUSKY C; HUSKY D
CHIP: The HUSKY Plan; HUSKY Plus;
HUSKY 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);
Med-Connect

HIS-501(C) (11-14-2013)

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CARD F14-DE
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
DELAWARE
Medicaid: Diamond State Health Plan
CHIP: Delaware Healthy Children Program
(DHCP)
State/Other: Children with Special Health
Care Needs (CSHCN): Children’s
Community Alternative
Disabilities Program

HIS-501(C) (11-14-2013)

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CARD F14-DC
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
DISTRICT OF COLUMBIA
Medicaid: DC Medicaid
CHIP: DC Healthy Families
State/Other: Catholic Charities; Health
Services for Children with
Special Needs; DC Healthcare
Alliance

HIS-501(C) (11-14-2013)

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CARD F14-FL
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
FLORIDA
Medicaid: MediPass
CHIP: KidCare; MediKids; Healthy Kids
State/Other: AIDS Insurance Continuation
Program (AICP); Children’s
Medical Services (CMS)

HIS-501(C) (11-14-2013)

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CARD F14-GA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
GEORGIA
Medicaid: Right from the Start (RSM); Health
Insurance Premium Payment
Program (HIPP); Katie
Beckett/TEFRA
CHIP: PeachCare for Kids
State/Other: Children’s Medical Services
(CMS); Indigent Care Trust Fund
(ICTF)

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CARD F14-HI
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
HAWAII
Medicaid: Hawaii-QUEST; Medicaid
Fee-for-Service
CHIP: Hawaii CHIP
State/Other: QUEST-Net; QUEST Expanded
Access (QExA); QUEST Adult
Coverage Expansion Program
(ACE); H-COBRA; Children with
Special Health Needs (CSHNP);
Transitional Medical Assistance
Program (TMA); State Medical
Assistance for Immigrant
Children Program; Basic Health
Hawaii

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CARD F14-ID
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
IDAHO
Medicaid: Healthy Connections
CHIP: Children’s Health Insurance
Program (CHIP); Access Card
State/Other: Catastrophic Fund; Children’s
Special Health Program (CSHP);
Access to Health Insurance
Program (AHI)

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CARD F14-IL
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
ILLINOIS
Medicaid: Medical Assistance; Healthy Start;
FamilyCare; Moms and Babies;
Illinois Health Connect; All Kids
CHIP: All Kids
State/Other: Division of Specialized Care for
Children (DSCC); Health Care for
Workers with Disabilities
(HBWD)

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CARD F14-IN
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
INDIANA
Medicaid: Traditional Medicaid; Hoosier
Healthwise; Indiana CareSelect
CHIP: Hoosier Healthwise for Children;
Children’s Health Plan; CHIP
Package C
State/Other: Children’s Special Health Care
Services (CSHCS); MED Works;
Healthy Indiana Plan (HIP)

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CARD F14-IA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
IOWA
Medicaid: Medical Assistance; Health
Insurance Premium Payment
(HIPP); MediPASS
CHIP: Health and Well Kids in Iowa (HAWK-I)
State/Other: Children’s Health Specialty
Clinics (CHSC); AIDS/HIV Health
Insurance Premium Payment;
IowaCare; Health Insurance
Plan of Iowa (HIP Iowa)

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CARD F14-KS
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
KANSAS
Medicaid: HealthConnect; HealthWave 19;
Kansas Medical Assistance
Program (KMAP); KanCare
CHIP: HealthWave 21
State/Other: Medi-KAN; Services for Children
with Special Health Care Needs
(CSHSN); Kansas Health
Insurance Association (KHIA)

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CARD F14-KY
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
KENTUCKY
Medicaid: Kentucky Patient Access and Care
System (KenPAC); KY Health
Choices; 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;
Medicaid Works

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CARD F14-LA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
LOUISIANA
Medicaid: Bayou Health; LaMoms
CHIP: LACHIP
State/Other: Louisiana Health Plan;
Children’s Special Health
Services (CSHS)

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CARD F14-ME
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
MAINE
Medicaid: MaineCare
CHIP: MaineCare for children
State/Other: Children with Special Health
Needs Program (CSHNP)

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CARD F14-MD
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by 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)

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CARD F14-MA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
MASSACHUSETTS
MASSACHUSETTS
Medicaid: MassHealth
CHIP: MassHealth
State/Other: Children’s Medical Security Plan
(CMSP); Commonwealth Care;
Commonwealth Choice; Medical
Security Plan (MSP); Special
Kids/Special Care; Children with
Special Health Care Needs;
Healthy Start; Health Safety Net
(HSN)

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CARD F14-MI
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
MICHIGAN
Medicaid: Medical Assistance Program;
Healthy Kids; MI-Choice; MI Card
CHIP: MIChild Program
State/Other: Children’s Special Health Care
Services (CSHCS)

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CARD F14-MN
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by 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)

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CARD F14-MS
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
MISSISSIPPI
Medicaid: Medical Assistance Program;
Infant Survival Program
CHIP: Mississippi Children’s Health Insurance
Program (CHIP)
State/Other: Children’s Medical Program

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CARD F14-MO
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
MISSOURI
Medicaid: MO HealthNet; Managed Care Plus
or MC+
CHIP: MO HealthNet for Kids (MHK); MC+
for Kids
State/Other: General Relief Medical
Assistance; Children with
Special Health Care Needs

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CARD F14-MT
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
MONTANA
Medicaid: Passport to Health; Healthy
Montana Kids Plus (HMK Plus)
CHIP: Montana’s CHIP; Healthy Montana
Kids Plus (HMK Plus)
State/Other: Health Insurance Continuum of
Coverage Program (HICCP);
Children’s Special Health
Services (CSHS)

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CARD F14-NE
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
NEBRASKA
Medicaid: Medical Assistance Program;
Nebraska Health Connection
(NHC)
CHIP: Kids Connection
State/Other: Medically Handicapped
Children’s Program (MHCP)

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CARD F14-NV
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
NEVADA
Medicaid: Nevada Medicaid; Child Health
Assurance Program (CHAP)
CHIP: Nevada Check Up
State/Other: Family Health Services Bureau;
Children with Special Health
Care Needs

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CARD F14-NH
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.

NEW HAMPSHIRE
Medicaid: Healthy Kids Gold; Health
Insurance Premium Payment
Program (HIPP)
CHIP: Healthy Kids Silver
State/Other: Special Medical Services (SMS);
Healthy Kids Buy-in;
Catastrophic Illness Program

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CARD F14-NJ
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
NEW JERSEY
Medicaid: AIDS Community Care
Alternatives (ACCAP)
CHIP: New Jersey Family Care
State/Other: Health Insurance Continuation
Program (HICP); Special Child
Adult and Early Intervention
Services (SCAEIS); New Jersey
Family Care Advantage

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CARD F14-NM
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
NEW MEXICO
Medicaid: Centennial Care; SALUD!; Medical
Assistance
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)

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CARD F14-NY
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
NEW YORK
Medicaid: The Partnership Plan
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)

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CARD F14-NC
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
NORTH CAROLINA
Medicaid: Community Care of North
Carolina/Carolina ACCESS
(CCNC/CA)
CHIP: NC Health Choice for Children (NCHC)
State/Other: Title V Services for Children
with Special Health Care Needs

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CARD F14-ND
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
NORTH DAKOTA
Medicaid: Primary Care Provider Program;
Primary Care Case Management
CHIP: Healthy Steps
State/Other: Children’s Special Health
Services (CSHS)

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CARD F14-OH
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by 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)

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CARD F14-OK
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
OKLAHOMA
Medicaid: SoonerCare
CHIP: Oklahoma SCHIP
State/Other: Children with Special Health
Care Needs (CSHCN); Oklahoma
Employer/Employee Partnership
for Insurance Coverage (O-EPIC)

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CARD F14-OR
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
OREGON
Medicaid: Medicaid State Plan; Oregon
Health Plan (OHP)
CHIP: Oregon SCHIP
State/Other: CareAssist; Oregon Services for
Children with Special Health
Needs; Family Health Insurance
Assistance Program (FHIAP);
Insurance Purchasing
Cooperative; Child Development
and Rehabilitation Center;
Oregon Healthy Kids

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CARD F14-PA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by 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;
Special Care

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CARD F14-RI
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
RHODE ISLAND
Medicaid: RIte Care; RI Medical Assistance;
Katie Beckett
CHIP: RIte Care
State/Other: Medical Assistance Program
for Children with Special
Health Care Needs; Rlte Share
Premium Assistance Program;
Rlte Care Health Insurance for
Family Child Care Providers

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CARD F14-SC
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
SOUTH CAROLINA
Medicaid: Healthy Connections; Partners for
Healthy Children (PHC); Health
Opportunity Accounts (HOA)
CHIP: Healthy Connections Kids
State/Other: Children’s Rehabilitative
Services (CRS); Medically
Indigent Assistance Program
(MIAP); Medically Fragile
Children’s Program

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CARD F14-SD
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
SOUTH DAKOTA
Medicaid: Medical Assistance
CHIP: CHIP
State/Other: Catastrophic County Poor Relief
Program (CCPR); Children’s
Special Health Services (CSHS);
Refugee Medical Assistance
(RMA); Disabled Children’s
Program

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CARD F14-TN
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
TENNESSEE
Medicaid: TennCare
CHIP: CoverKids; TENNderCare
State/Other: Children’s Special Services
(CSS); CoverTN; AccessTN

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CARD F14-TX
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS

Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
TEXAS
Medicaid: The State Plan; State of Texas
Access Reform (STAR); Star+Plus
CHIP: Texas CHIP
State/Other: State Kid Insurance Program
(SKIP); Children with Special
Health Care Needs (CSHCN)

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CARD F14-UT
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
UTAH
Medicaid: Utah Medicaid
CHIP: Children’s Health Insurance Program
(CHIP)
State/Other: Primary Care Network (PCN);
Custody Medical Care Program;
Children with Special Health
Care Needs (CSHCN); Health
Insurance Continuation
Program; Utah’s Premium
Partnership for Health Insurance
(UPP)

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CARD F14-VT
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
VERMONT
Medicaid: Primary Care Plus (PC Plus); Green
Mountain Care
CHIP: Dr. Dynasaur
State/Other: Vermont Health Access Plan
(VHAP); HIV Insurance
Continuation Program (ICAP);
Children with Special Health
Needs (CSHN); Catamount
Health with Premium
Assistance (CHAP)

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CARD F14-VA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
VIRGINIA
Medicaid: Medicaid; Medallion; Medallion II
CHIP: Family Access to Medical Insurance
Security Plan (FAMIS); FAMIS Select
State/Other: State and Local Hospitalization
(SLH) Program; Children with
Special Health Care Needs
(CSHCN); Plan First

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CARD F14-WA
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
WASHINGTON
Medicaid: Apple Health for Kids; Healthy
Options; Washington Basic Health
Plus (BH+)
CHIP: Apple Health for Kids with premium
State/Other: Washington Basic Health;
Children with Special Health
Care Needs (CSHCN); Medical
Care Services (MCS); Healthcare
for Workers with Disabilities
(HWD); Washington Medicaid
Integration Partnership (WMIP)

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CARD F14-WV
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
WEST VIRGINIA
Medicaid: Mountain Health Trust; Mountain
Health Choices; Physician Assured
Access System (PAAS)
CHIP: WVCHIP
State/Other: Children with Special Health
Care Needs (CSHCN); Health
Insurance Premium Payment
Program (HIPP)

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CARD F14-WI
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
WISCONSIN
Medicaid: Medical Assistance MA; Healthy
Start; ForwardHealth
CHIP: BadgerCare
State/Other: Wisconsin AIDS/HIV Health
Insurance Premium Subsidy
Program; Children and Youth
with Special Health Care Needs
(CYSHCN); BadgerCare Plus

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CARD F14-WY
STATE NAMES FOR MEDICAID, CHIP,
STATE-/LOCAL-SPONSORED, AND OTHER
HEALTH INSURANCE PROGRAMS
Note: Medicaid programs are often called
"Medicaid", "Medical Assistance Program", or
"Title 19". Children’s Health Insurance Programs
are often called "CHIP", "SCHIP", or "Title XXI
Program". Many states have unique names for
their health insurance programs. Those program
names are listed below, by state.
WYOMING
Medicaid: EqualityCare
CHIP: CHIP Kid Care
State/Other: Children’s Special Health
Services (CSH)

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HIS-501(C) (11-14-2013)

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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)

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Card F15

6. Disability insurance (cash payments
when unable to work for health reasons)

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)

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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

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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)

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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

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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

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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)

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Card F20
Card F21

CARD F21

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

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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

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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. Diabetes
7. Arthritis
8. Congenital heart disease
9. Other heart condition

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CARD C3
0. Not true
1. Sometimes true
2. Often true

Card C2
Card C3

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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

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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

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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

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CARD C7

1. Not true
2. Somewhat true
3. Certainly true

Card C6
Card C7

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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

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CARD A1

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

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Card C8
Card A1

1. Working for pay at a job or business

CARD A2
1. An employee of a PRIVATE company,
business, or individual for wages,
salary, or commission
2. A FEDERAL government employee
3. A STATE 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

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CARD A3
1. 1–9 employees
2. 10–24 employees
3. 25–49 employees
4. 50–99 employees

6. 250–499 employees
7. 500–999 employees
8. 1000 employees or more

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Card A2
Card A3

5. 100–249 employees

CARD A4
1. Advise them to drive to the hospital
2. Advise them to call their physician
3. Call 9-1-1 (or another emergency number)
4. Call spouse or family member
5. Other

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CARD A5
You may choose more than one.

Card A4
Card A5

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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

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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

15. Other developmental problem (for
example, cerebral palsy)
16. Senility
17. Depression/anxiety/emotional problem
18. Weight problem
Other impairment/problem
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Card A6
Card A7

14. Intellectual disability, also known
as mental retardation

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

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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

Card A8
Card A9

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CARD A10
1. 1
2. 2 – 3
3. 4 – 5
4. 6 – 7
5. 8 – 9
6. 10 – 12
7. 13 – 15
8. 16 or more

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CARD ASI1
Card A10
Card ASI1

1. Gay
2. Straight, that is, not gay
3. Bisexual
4. Something else
5. I don’t know the answer

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CARD ASI2

1. Lesbian or gay
2. Straight, that is, not lesbian or gay
3. Bisexual
4. Something else
5. I don’t know the answer

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CARD ASI3

1. You are not straight, but identify with
another label such as queer, trisexual,
omnisexual or pansexual

3. You have not figured out or are in the
process of figuring out your sexuality
4. You do not think of yourself as having
sexuality
5. You do not use labels to identify
yourself
6. You mean something else

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Card ASI2
Card ASI3

2. You are transgender, transsexual or
gender variant

CARD ASI4

1. You don’t understand the words
2. You understand the words, but you
have not figured out or are in the
process of figuring out your sexuality
3. You mean something else

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CARD ASI5

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

Card ASI4
Card ASI5

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CARD ASI6

1. It’s unlikely you’ve been exposed to HIV
2. You were afraid to find out if you were
HIV positive (that you had HIV)
3. You didn’t want to think about HIV or
about being HIV positive
4. You were worried your name would be
reported to the government if you
tested positive
5. You didn’t know where to get tested
6. You don’t like needles
7. You were afraid of losing your job,
insurance, housing, friends, family, if
people knew you were positive for AIDS
infection
8. Some other reason
9. No particular reason

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EXPLANATION OF THE NATIONAL HEALTH
INTERVIEW SURVEY (SPANISH)
EXPLICACIÓN DE LA ENCUESTA NACIONAL
DE ENTREVISTAS DE SALUD
El propósito de la Encuesta Nacional de Entrevistas de Salud (NHIS, siglas en ingles), 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 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.
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 Centros 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 de Salud?" (Answer any questions) ¿Esta 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
Centros 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)

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Card ASI6
Introduction (Spanish)

"Soy __________ de la Oficina del Censo de los Estados Unidos. Estamos llevando a
cabo una encuesta sobre la salud para el Centros 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."

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."

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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.
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

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.

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Introduction (English)
Adding Extra Units

Adding NHIS Extra Units to Case Management

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

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Outcome Codes
Instrument Flowchart

Page 115

HIS-501(C) (11-14-2013)

2014 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) (11-14-2013)

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2014 NHIS Checklist

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Page 117