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Informed Participation

Endorsement Status
1.1 New or Maintenance
E&M Cycle
Is Under Review
1.3 Measure Description

Improved measurement of the continuity of insurance coverage in the Medicaid and CHIP population is needed to help maximize insurance continuity and coverage for vulnerable children. To further this goal, the AHRQ-CMS CHIPRA PQMP Center of Excellence at the Children’s Hospital of Philadelphia developed the metric Informed Coverage. The metric is designed to more accurately measure coverage among children enrolled in Medicaid or CHIP at the state level and overcome the current inability in the Medicaid Analytic eXtract (MAX) dataset to determine whether a child disenrolled from Medicaid and CHIP due to loss of eligibility (such as due to parental income increase or the acquisition of employer-sponsored insurance, a “good” reason) or failure to appropriately re-enroll (a “bad” reason). This measure can help federal and state programs develop strategies to retain children eligible for coverage and minimize gaps that can occur during the renewal process. Informed Coverage assesses the continuity of enrollment of children in publicly financed insurance programs (Medicaid and CHIP), as defined by the ratio of enrolled month to eligible months over an 18 month observation window. Informed Coverage uses a natural experiment based on the random event of appendicitis to “inform” the estimate of coverage in a given state, bounded by two extreme assumptions regarding unknown eligibility information: Coverage Presumed Eligible (PE) and Coverage Presumed Ineligible (PI).

        • 1.14 Numerator

          The numerator for Informed Coverage represents the sum (within a state) of months enrolled in Medicaid/CHIP for all children over an 18-month window.

        • 1.15 Denominator

          The sum (within a state) of months eligible for Medicaid/CHIP for all children (0-18 years) over an 18-month window. In addition, months that could be defined as “eligible” are based on known events recorded in the MAX data that would affect eligibility (birth or ageing out).

        • Exclusions

          For the appendicitis calculation, the population is limited to children between the ages of 2 to 16 years old. To determine what is the best assumption to use (either the Appendectomy Coverage Rate (or ACR), PI, or PE) inside each state, we compare the observed appendectomy coverage rate in a state, to the estimated coverage rate that would be calculated in that state with either PI, or PE assumptions.

        • Most Recent Endorsement Activity
          Measure Retired and Endorsement Removed Prevention and Population Health Fall Cycle 2021
          Initial Endorsement
          Last Updated
          Removal Date