21. Appendix I: Scoring Scenarios for Public Health Care Coverage

This section addresses scoring scenarios involving the overlap of Insurance Coverage, Expected Payer/Public Assistance and Means-Tested Programs, and Geography. Below are three key points that summarize all the scenarios:

1. If the data is ONLY related to Residence or Service Geography, then DO NOT USE Insurance Coverage or Means-Tested Tables.

2. Means-Tested Programs—Only add interaction if enrollment in the Public Assistance program is 10 million or fewer people. No interaction is needed for Medi-Cal as the current enrollment is approximately 14 million, which exceeds 10 million.

3. If the number of members enrolled in Insurance Coverage is less than the population of the geographic subdivision, then use the Insurance Table. If the number of members enrolled in Insurance Coverage is greater than or equal to the population of the geographic subdivision, then use the Geography Table.

Table 36: Scoring Scenarios for Insurance Coverage and Geography Data that Includes Public Programs

In the table below, the examples assume annual data (+0 score) with under 11 events (+7 score) along with other dataset characteristics described under the Dataset Example column. A Yes entry indicates that the applicable score for that variable should be added in the Total Risk Score.

*Base Score includes reporting time (annual), events, Expected Payer / Public Assistance or Means-Tested programs, and interaction.

Dataset Example: Annual Data (+0) <11 events (+7)	Insurance Coverage	Expected Payer/ Public Assistance and Means-Tested Programs	Geography	Interaction	Total Risk Score
Events, Statewide data					Safe Harbor if Statewide and Annual data
Events, County-level data (Includes regional and other sub-state geographies)			Yes		Base score*: +7 Examples based on county population: · Alpine (population <4,000): 7+7=14 · Pop size of 10,000: 7+5=12 · Pop size of 30k: 7+4=11
Events, Means-Tested Programs, Statewide		Yes	Yes	+1, if enrollment in Means-Tested Programs is less than 10 million people	Base score*: +7 Examples based on public assistance program size: · Medi-Cal (~14 million) = 7-5+0+0= 2 · Self-Pay/Uninsured (~2.7 million) = 7-5+2+1=5 · CalFresh (5.5 million) = 7-5+1+1=4 · WIC (1 million) = 7-5+2+1=5 · CalWORKS, HSP (13,000) = 7-5+7+1= 10
Events, Means-Tested Programs, County-level data (Includes regional and other sub-state geographies)		Yes	Yes Example: Alpine- 1,163 (+7)	+1, if enrollment in Means-Tested Programs is less than 10 million people	Base score*: +7 Examples based on public assistance program size: · Medi-Cal (~14 million)= 7+7+0+0= 14 · Self-Pay/Uninsured (~ 2.7 million) = 7+7+2+1=17 · CalFresh (5.5 million) = 7+7+1+1=16 · WIC (1 million) = 7+7+2+1=17 · CalWORKS, HSP (13,000) = 7+7+7+1= 22
Health plans / Insurers	Yes				Base score*: +7 Examples based on Insurance Coverage enrollment: · Enrollment <4,000): 7+5=12 · Enrollment of 10,000: 7+5=12 · Enrollment of 30k: 7+4=11
Health plans / Insurers, including Medi-Cal, and no specific geographic coverage and no other public coverage	Yes	+0, since enrollment in Medi-Cal is approx.14 million people		+0, since enrollment in Medi-Cal is approx.14 million people	Base score*: 7+0+0 = +7 Examples based on Insurance Coverage enrollment: · Enrollment <4,000): 7+5 =12 · Enrollment of 10,000: 7+5=12 · Enrollment of 30k: 7+4=11
Health plans / Insurers, including Medi-Cal, and no other public coverage, County-level data (Includes regional and other sub-state geographies)	Yes, if the Insurance Coverage population is less than the geography population	+0, since enrollment in Medi-Cal is approx.14 million people	Yes, if the Insurance Coverage population greater than or equal to the geography population	+0	Base score*: 7+0+0 = 7 If Ins Cov. Population < Geography Population, then use Ins Cov. Table: Examples based on Insurance Coverage enrollment: · Enrollment <4,000):7+5=12 · Enrollment of 10,000: 7+5=12 · Enrollment of 30k: 7+4=11 Else, use Geography Table Examples based on Residence Geography: · Population <4,000): 7+7=14 · Population of 10,000: 7+5=12 · Population of 30k: 7+4=11
Health plans / Insurers, Means-Tested Programs with less than 10 million enrolled	Yes	Yes Example: WIC (1 million) (+2)		+1 enrollment in Means-Tested Program is less than 10 million people	Base score*: 7+2+1 = +10 Examples based on Insurance Coverage enrollment: · Enrollment of 10,000: 10+5=15 · Enrollment of 30k: 10+4=14 · Enrollment of 150k: 10+1=11
Health plans / Insurers, Means-Tested Programs with less than 10 million enrolled, County-level data (Includes regional and other sub-state geographies)	Yes, if the Insurance Coverage population is less than the geography population	Yes Example: WIC (1 million) (+2)	Yes, if the Insurance Coverage population greater than or equal to the geography population	+1 enrollment in Means-Tested Program is less than 10 million people	Base score*: 7+2+1 = +10 If Ins Cov. < Geography, then use Ins Cov. Table: Examples based on Insurance Coverage enrollment: · Enrollment < 10,000: 10+5=15 · Enrollment of 30k: 10+4=14 · Enrollment of 150k: 10+1=11 Else, use Geography Table Examples based on Residence Geography: · Population <4,000: 10+7=17 · Population of 10,000: 10+5=15 · Population of 30k: 10+4=14 · Population of 150k: 10+1=11