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Background
Data Element 4.04 Health Insurance is collected to determine whether clients are accessing all mainstream medical assistance benefits for which they may be eligible along with changes between project start and exit. This data element provides information about the characteristics of clients, the services that are provided, and client outcomes. For additional information, please refer to the HMIS Data Standard Manual.
Data Element 4.04 Health Insurance
In this Knowledge Base article, we will take a closer look at the Health Insurance Data Element, the field number for this data element can vary between different program types but this data is collected for all programs. For a full list of responses, please refer to the HMIS Data Standard Manual.
- Project Type Applicability: All Programs - All Components
- Data Collected About: All Clients
- Collection Point: Project Start, Update, Annual Assessment, and Project Exit
- Screens in HMIS: Enrollment Screen, Status Update Assessment Screen, Annual Assessment Screen, and End Program Screen
When recording if a client is covered by health insurance, it is intended to identify actual health insurance sources. Indigent care received by a medical provider or hospital to cover a health care costs does not constitute health insurance coverage and should not be recorded in HMIS.
Medical and dental health coverage provided through Ryan White funding is not considered health insurance. If this is the only health coverage a client has, record "No" in the field 'Covered by Health Insurance.' Housing Opportunities for Persons With AIDS (HOPWA) providers record Ryan White health services in data element W3 Medical Assistance (see HOPWA Program HMIS Manual).
If there is a "No" response to 'Covered by Health Insurance' then the HMIS must automatically record all sources as "No."
If there is a "Client doesn't know" response, "Client refused" response, or "Data not collected response to 'Covered by Health Insurance' then the insurance sources will not populate.
If there is a "Yes" response to 'Covered by Health Insurance' then at least one source of health insurance must be identified. Updates are required for persons aging into adulthood.
How to Determine Health Insurance source
Clients that receive General Relief (GR) or Supplemental Security Income (SSI) typically receive Medicaid (Medi-Cal aka CalOptima). Medicaid is a partnership between federal and state funds. It should always be listed as Medicaid, not State Health Insurance.
Clients that receive Social Security Disability Insurance (SSDI) or retirement benefits typically receive Medicare.
Clients can receive both Medi-Cal and Medicare which is sometimes referred to as Medi-Medi. In this case enable both Medicaid and Medicare.
Clients that can provide a insurance company or agency name such as Kaiser, Blue Shield, CalOptima, etc. should select Other for the insurance source. However, prior to selecting other, the HMIS User should ask probing questions to identify how the insurance is being paid, as the insurance may be paid by one of the listed health insurance options.
The following video has information on this field and where you can find this information in HMIS Data Standard Manual.
