state insurance exchange and regulation, provide for possible public plan implementation at the state level, and to implement insurance regulations, including young adult dependent coverage.

A continuing responsibility for states is to meet CHIP reporting requirements, which are largely established by the Centers for Medicare & Medicaid Services (CMS). These constitute a series of annual state reports to CMS on progress in reducing the number of uninsured children, to be submitted in specified formats with data elements established in the CMS reporting programs (see Chapter 4). The requirements of the CHIP challenge, discussed in Chapter 2, now require updates with estimates of coverage on a semiannual basis.

States also have a need to effectively target outreach, enrollment, and safety net strategies. Information is needed on insurance status, age, substate geographic location, income, and race/ethnicity in order to guide and assess these activities.

And states need to prepare budgets, and, to properly accomplish the budgeting function, they need to be able to forecast activities. For the most part, inputs to forecasting models are based on expansion or contraction activities. As part of the budget process, states need to prepare and justify distribution formulas for state funds to localities, Blewett observed.

She suggested that, in order to accomplish the various responsibilities outlined above, a set series of state data requirements has evolved, generally characterized by:

  1. a state representative sample;

  2. a large enough sample and a sample frame that provides for reliable estimates for subpopulations including low-income children, race/ethnic groups, and geographic areas, such as county or region;

  3. timely release of data, including tabulated estimates of health insurance coverage released within a year of data collection; and

  4. access to microdata through readily available public-use files with state identifiers to allow states do conduct their own analysis and policy simulations.


For the reasons given in Chapters 3 and 4, the current federal surveys and national administrative databases have not been judged sufficient to fulfill these data requirements, so states have for some time sponsored their own ongoing surveys. Blewett reported that 19 states have used an instrument called the Coordinated State Coverage Survey (CSCS), which

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