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Survey Items: Survey instrument item number for children 0-5 years: E1, E3, E5, E6, F1, F2; for children 6-11 years: E1, E3, E5, E6, F1, F2; for children 12-17 years: E1, E3, E5, E6, F1, F2 Variables in public use data file: CURRINS (derived); INSGAP (derived); K3Q20; K3Q22; HOWMUCH; K3Q21B
Denominator: Children age 0-17 years
Numerator: Current insurance is adequate and continuous; Current insurance is inadequate and/or had gap in coverage in past year
Revisions and Changes: In 2024, this measure was included as a Standardized Measure for the first time. This measure was previously reported as a National Performance Measure. The survey items for this measure have not changed since 2016. In 2024, the Title V NPMs and NOMs were updated. Some measures have new denominators (subsets of children) and some new measures have been added. Several NPMs and NOMs are measured with two different denominators: all children and only children with special health care needs (CSHCN). Some measures are no longer NPMs and NOMs and are now classified as Standardized Measures. For more information on the Title V MCH Block Grant measures, review this document.
Additional Notes: To qualify on this measure the child must meet the following two criteria: 1) have continuous insurance in the past 12 months, and 2) have current insurance which is adequate for the child’s healthcare needs. The child’s current insurance was considered adequate when the following criteria were met: (a) the child currently has health insurance coverage, AND (b) benefits usually or always meet child's needs, AND (c) the insurance usually or always allows the child to see needed providers, AND (d) the insurance either has no out-of-pocket expenses or out-of-pocket expenses are usually or always reasonable. The measure is only considered missing if both items are missing. Therefore, children with a valid, positive response to either portion of the measure and missing to the other portion are categorized as having adequate and continuous insurance.
Treatment of Unknown Values: Missing values may be due to non-response (i.e. a skipped item) or a “don’t know” response. The way these items are handled can vary by measure. For Title V Maternal and Child Health Services Block Grant Measures, having missing values for all items in an indicator will lead to the case being given a missing value on the overall measure. For some other measures, if there is a missing value on any of the items, the case will be set to missing. How missing values are handled is documented in the "Additional notes" field above when required. Missing values are not included in the denominator when calculating prevalence estimates and weighted population counts displayed in the Interactive Data Query results table. In the majority of cases, the proportion of missing values is less than 5%. Exceptions are noted in the form of a Data Alert at the bottom of a results table. The exclusion of these values does not change the prevalence estimates (%) and only marginally affects the weighted population counts (Pop. Est.). To learn about the impact of the missing values on the population count estimates, click here.
History and Development: Overview of the Title V Block Grant The Title V Maternal and Child Health (MCH) Services Block Grant Program is a federal-state partnership to improve the health and well-being of mothers, children (including children with special health care needs) and their families in all 59 states and jurisdictions. The Title V MCH Block Grant Performance Measure Framework enables states to demonstrate the impacts of Title V within a state. The performance measurement system utilizes national data sources, including the NSCH, to track the ultimate outcomes of the program -- National Outcome Measures (NOMs) – and the key metrics of health behavior or health care access and quality -- National Performance Measures (NPMs) -- that influence NOMs. In 2024, the Title V NPMs and NOMs were updated. Some measures have new denominators (subsets of children) and some new measures have been added. Some measures are no longer NPMs and NOMs and are now classified as Standardized Measures. For more information on NPM and NOM content changes, click here. More information about the Title V MCH Block Grant and performance measurement system can be obtained at the MCHB website. About NSCH The National Survey of Children’s Health (NSCH), funded and directed by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), is designed to provide annual national and state-level information on the health and well-being of children ages 0-17 years in the United States. The U.S. Census Bureau administers the survey, oversees the sampling, and produces a final data set of survey results. HRSA’s Maternal and Child Health Bureau (MCHB) develops survey content in collaboration with the U.S. Census Bureau and a Technical Expert Panel. The Technical Expert Panel consists of experts in survey methodology and children’s health, federal and state stakeholders, clinicians and researchers. In 2016, the NSCH underwent a significant redesign which combined content from both the NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). Further information on that redesign can be found in “The Design and Implementation of the 2016 National Survey of Children’s Health”. The NSCH is conducted as a household survey, and one child per household is selected to be the subject for the detailed age-specific questionnaire. The respondent to this questionnaire is a parent or guardian who is living in the home and has knowledge of the sampled child. Survey participants complete either web-based or self-administered paper-and-pencil questionnaires. Data from the NSCH is used for scientific research, federal policy and program development, and state-level planning and performance reporting. Information is collected on factors related to the health and well-being of children, including access to and utilization of health care, receipt of care in a medical home, systems of care for CSHCN, family interactions, parental health, school and after-school experiences, and neighborhood characteristics. More information about the survey can be found in the “About the National Survey of Children's Health” section of this website and HRSA’s MCHB website.
C.I. = 95% Confidence Interval. Percentages and population estimates (Pop.Est.) are weighted to represent child population in US.
DATA ALERT: CSHCN status is determined using a validated instrument for identification of children with special health care needs as defined by the federal Maternal and Child Health Bureau. The CSHCN Screener asks whether a child currently experiences a health consequence and, if so, whether that specific health consequence is due to a medical, behavioral, or other type of health condition that has lasted, or is expected to last, 12 months or longer. For more information, email info@cahmi.org.
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Data Source: National Survey of Children’s Health, Health Resources and Services Administration, Maternal and Child Health Bureau. https://mchb.hrsa.gov/data/national-surveys
Citation: Child and Adolescent Health Measurement Initiative. 2021-2022 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved [mm/dd/yy] from [www.childhealthdata.org].