Joanna Turner
State Health Access Data Assistance Center (SHADAC)
University of Minnesota
MN Health Services Research Conf...
• Funding Master text is supported by the U.S.
Click to edit for this workstyles
Censuslevel
Second Bureau
Third level
Fou...
• Administrative datatextpublic assistance programs are not
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sufficient for policy making
Se...
• SNACC Phases I-VI (2007-2010)
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• CPS level 2005) implied undercount of 40.8%
Second (CY...
• Collaboration between Census Bureau and SHADAC
Click to edit Master text styles
to extend previous Medicaid undercount r...
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• Large, continuous, multi-mode survey of the US
Second level
population residing in hous...
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Second level
“Is this person CURRENTLY covered by any of the
Third level
following types ...
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• Medicaid enrollment records
Second level
• Longitudinal database of enrollment
Third le...
• MSIS includes comprehensive and partial coverage
Click to edit Master text styles
• ACS comprehensive coverage is a subs...
• Discordance between MSIS
Click to edit Master text styles and ACS can come from
definitional differences and survey resp...
• Use edit Master text styles
Click to linking methodology developed by the Census
Bureau’s Center for Administrative Reco...
• Consider a case to have Medicaid enrollment if they
Click to edit Master text styles
are covered on the day of ACS inter...
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ACS
Second level
Yes
No
Third level
Fourth level
Fifth level

MSIS

Yes
No

13
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Second level
Third level
Fourth level
Total Population of
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Linked Cases
Any Me...
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Second level
Third level
Fourth level
Total Population of
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Linked Cases
Any Me...
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AnySecond level
Medicaid Plus
Third level
NOT Any Medicaid Plus
Fourth level
Employer spo...
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Second level
Third level
Fourth level
Fifth level

Source: 2008 MSIS and ACS civilian non...
• A to edit Master text the share of the population that
Click key policy metric isstyles
lacks any type of coverage
Secon...
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Second level
Third level
Fourth level
Original uninsured estimate
Fifth level

Share of t...
• Although not perfectly comparable, the undercount in the
Click to edit Master text styles surveys
ACS appears in line wi...
Click to edit Master text styles
Second level

Joanna Turner
Fourth level
turn0053@umn.edu
Fifth level
612.624.4802

Third...
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Medicaid Undercount in the American Community Survey: How does Minnesota Compare with other States?

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Medicaid Undercount in the American Community Survey: How does Minnesota Compare with other States?

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Medicaid Undercount in the American Community Survey: How does Minnesota Compare with other States?

  1. 1. Joanna Turner State Health Access Data Assistance Center (SHADAC) University of Minnesota MN Health Services Research Conference St. Paul, MN March 4, 2014
  2. 2. • Funding Master text is supported by the U.S. Click to edit for this workstyles Censuslevel Second Bureau Third level Fourth level Fifth level • Collaborators: • • Brett O’Hara (Census Bureau) Kathleen Call, Michel Boudreaux, Brett Fried (SHADAC) 2
  3. 3. • Administrative datatextpublic assistance programs are not Click to edit Master on styles sufficient for policy making Second level • • • • Not timely Third level No population denominator Fourth level Incomplete or lower quality covariates Fifth level Population surveys fill these gaps • Yet they universally undercount public program enrollment described in administrative data • • Food stamps, public housing, TANF (Lewis, Elwood, and Czajka 1998; Meyer, 2003) Medicaid (Call et al 2008, 2012) 3
  4. 4. • SNACC Phases I-VI (2007-2010) Click to edit Master text styles • CPS level 2005) implied undercount of 40.8% Second (CY • NHISlevel 2002) implied undercount of 33.5% Third (CY Fourth level • O’Hara (2009) • Fifth level ACS Content Test (CY 2006) implied undercount of 34.4% for the non-elderly • Turner & Boudreaux (2010) • 2008 ACS produces coverage estimates similar to other population surveys (e.g. 2008 NHIS) 4
  5. 5. • Collaboration between Census Bureau and SHADAC Click to edit Master text styles to extend previous Medicaid undercount research to Second level theThird level Community Survey (ACS) American Fourth level • Describe Fifth level the concordance of Medicaid reporting in the ACS and enrollment data in administrative records • Bias to uninsurance estimates 5
  6. 6. Click to edit Master text styles • Large, continuous, multi-mode survey of the US Second level population residing in housing units and group Third level quarters level Fourth Fifth level • Added health insurance question in 2008 • One simple multi-part question on health insurance type • Unique data source due to its size • Subgroup analysis (small demographic groups and low levels of geography) 6
  7. 7. Click to edit Master text styles Second level “Is this person CURRENTLY covered by any of the Third level following types of health insurance or health Fourth level coverageFifth level plans? d. Medicaid, Medical Assistance, or any kind of governmentassistance plan for those with low incomes or a disability?” 7
  8. 8. Click to edit Master text styles • Medicaid enrollment records Second level • Longitudinal database of enrollment Third level • • • Fourth originate in the states and are reported to the Records level federal Fifth level government Includes regular Medicaid and Expansion CHIP Tracks all levels of enrollment (e.g., emergency & dental) • Not a perfect gold standard 8
  9. 9. • MSIS includes comprehensive and partial coverage Click to edit Master text styles • ACS comprehensive coverage is a subset Second level Third level Fourth level Fifth level • ACS includes Medicaid, CHIP, and state-specific public programs (will refer to coverage as “Medicaid Plus”) • MSIS Medicaid and Expansion CHIP coverage is a subset 9
  10. 10. • Discordance between MSIS Click to edit Master text styles and ACS can come from definitional differences and survey response error Second level Third level Fourth level Fifth level • Our focus here is on survey response errors which we investigate by merging the ACS and the MSIS 10
  11. 11. • Use edit Master text styles Click to linking methodology developed by the Census Bureau’s Center for Administrative Records Second level Third level Research and Applications • Fourth Personallevel Identification Key (PIK) Fifth level • Research conducted at the MN Census Research Data Center located at the University of Minnesota • http://mnrdc.umn.edu/ 11
  12. 12. • Consider a case to have Medicaid enrollment if they Click to edit Master text styles are covered on the day of ACS interview by full Second level Third level benefit coverage from Medicaid or Expansion CHIP Fourth level • Adjust ACS person weights to account for unlinkable Fifth level records • Although all persons were linked estimates reported here are for the civilian non-institutionalized population 12
  13. 13. Click to edit Master text styles ACS Second level Yes No Third level Fourth level Fifth level MSIS Yes No 13
  14. 14. Click to edit Master text styles Second level Third level Fourth level Total Population of Fifth level Linked Cases Any Medicaid Plus Implied Undercount Total Age 0-18 32.8 million 77.1 (0.12) 22.9 (0.12) 19-64 65+ 18.8 million 79.9 (0.16) 20.1 (0.16) 11.5 million 73.0 (0.16) 27.0 (0.16) 2.5 million 75.2 (0.32) 24.8 (0.32) Source: 2008 MSIS and ACS civilian noninstitutionalized population as analyzed by SHADAC. Percent (Standard error) 14
  15. 15. Click to edit Master text styles Second level Third level Fourth level Total Population of Fifth level Linked Cases Any Medicaid Plus Implied Undercount % of Poverty 0-138 139-200 201+ 20.1 million 82.9 (0.15) 17.1 (0.15) 5.2 million 71.6 (0.33) 28.4 (0.33) 7.1 million 64.4 (0.27) 35.6 (0.27) Source: 2008 MSIS and ACS civilian non-institutionalized population as analyzed by SHADAC. Percent (Standard error) 15
  16. 16. Click to edit Master text styles AnySecond level Medicaid Plus Third level NOT Any Medicaid Plus Fourth level Employer sponsored insurance Fifth level 77.1 (0.12) 22.9 (0.12) 8.3 (0.08) Direct purchase 2.2 (0.05) Medicare 3.3 (0.04) TRICARE 0.3 (0.01) VA 0.1 (0.01) Uninsured 9.9 (0.08) Source: 2008 MSIS and ACS civilian non-institutionalized population as analyzed by SHADAC. Percent (Standard error) 16
  17. 17. Click to edit Master text styles Second level Third level Fourth level Fifth level Source: 2008 MSIS and ACS civilian non-institutionalized population as analyzed by SHADAC 17
  18. 18. • A to edit Master text the share of the population that Click key policy metric isstyles lacks any type of coverage Second level Third level • Uninsurance is a residual category, so undercounting Fourth level Medicaid Fifth level contributes to bias in uninsurance partially • • We cannot estimate bias from other sources of coverage We cannot estimate bias from those that report Medicaid, but are in fact uninsured 18
  19. 19. Click to edit Master text styles Second level Third level Fourth level Original uninsured estimate Fifth level Share of the uninsured that are linked Partially adjusted uninsured estimate Count in millions 40.9 3.2 37.7 Percent (SE) 15.4 (0.05) 7.9 (0.07) 14.2 (0.04) Source: 2008 MSIS and ACS civilian non-institutionalized population as analyzed by SHADAC. 19
  20. 20. • Although not perfectly comparable, the undercount in the Click to edit Master text styles surveys ACS appears in line with other Second level • Large (22.9%), but slightly better than some other Third level surveys (keep in mind ACS includes Medicaid and other Fourth level means-tested public coverage) Fifth level • As with other surveys the undercount increases with age and family income and appears to vary by state • The undercount translates into an overestimate of uninsurance of 1.2 percentage points or 3.2 million but it is likely that there are other offsetting influences 20
  21. 21. Click to edit Master text styles Second level Joanna Turner Fourth level turn0053@umn.edu Fifth level 612.624.4802 Third level www.shadac.org @shadac

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