Ron Prevost

1
The Medicaid Differential Project andPreliminary
Results

• Ron Prevost
• U.S. Census Bureau
• NAWRS 46th Annual Workshop
• August 22, 2006

2
Overview

• Phase I II Study Results Continuation of Dave
  Baughs Presentation
• Medicaid Study Elements - Phases III IV
• The Census Bureaus Administrative Records
  Infrastructure
• New and Emerging Applications of Administrative
  Records

3
Project Collaborators and Co-Authors

• Collaborators
• US Census Bureau Collaborators
• Sally Obenski
• Ron Prevost
• Dean Michael Resnick
• Marc Roemer
• Office of the Assistant Secretary for Planning
  and Evaluation
• Rob Stewart
• George Greenberg
• Kate Bloniarz
• Coauthors
• Centers for Medicare and Medicaid Services
• Dave Baugh
• Gary Ciborowski
• State Health Access Data Assistance Center
• Kathleen Thiede Call

4
Preliminary explanations we are reporting on today

• Universe differences
• Enforce CPS group quarter definitions on MSIS
  where we have administrative data address
  information
• Look for duplicate persons in different states or
  same state
• Measurement error
• Link CPS respondents to MSIS data for CY 2000 to
  examine survey reports of enrollees
• Understand the covariates of misreporting

5
Building a common universe
Not a valid record
Group quarters, dead, not a valid record, in two
states
In CPS universe and in MSIS universe
6
Preparing MSIS data for comparison and linking to
CPS

• Removed MSIS dual eligible cases defined as a
  group quarter by Census
• Ran the 2000 MSIS data through Census Bureaus
  Person-ID validation system
• A record is valid if in the appropriate format
  and demographic data is consistent
• Removed duplicate valid records
• Removed those MSIS enrollees not enrolled in
  full benefits

7
Matching the CPS universe

• Number of MSIS Medicaid Records in 2000
• 44.3 M (total MSIS records)
• - 1.5 M (records in more than one state or
  group quarter)
• - 4.0 M (partial Medicaid benefits)
• 38.8 M (the target Medicaid total)

8
Sample loss in the 2000 MSIS and 2001 CPS linking

• MSIS
• 9 of all MSIS records did not have a valid
  record and were not eligible to be linked to the
  CPS
• CPS
• 6.1 (respondents records not validated)
• 21.5 (respondents refused to have their
  ______ data linked)
• 27.6 (total not eligible to be linked to MSIS)

9
The matched CPS-MSIS respondents with reported
data only

• 12,341 CPS person records matched into the MSIS
• 1,906 records had imputed or edited CPS data
  (15.5 of total).
• Focusing on only those with explicitly reported
  data
• 60 (responded they had Medicaid)
• 9 (responded some other type of public
  coverage but not Medicaid)
• 17 (responded some type of private coverage,
  but not Medicaid)
• 15 (responded they were uninsured)
• 101 (over 100 due to rounding)

10
What factors are associated with measurement
accuracy/error?

• Length of time enrolled in Medicaid
• Recency of enrollment in Medicaid
• Poverty status impacts Medicaid reporting but
  does not impact the percent reporting they are
  uninsured
• Adults 18-44 are less likely to report Medicaid
  enrollment
• Adults 18-44 more likely to report being
  uninsured
• Overall CPS rate of those with Medicaid reporting
  that they are uninsured is higher than other
  studies
• Overall CPS rate of those with Medicaid reporting
  Medicaid is lower than other studies

11
Explanations of the undercount revisited work
remaining to be done

• Phase III Measure Universe Differences
• Use 7 Medicaid state files with name and address
  information to understand the impact of MSIS
  non-validation (one of the states is CA)
• Use enhanced MSIS data to further analyze the CPS
  sample frame coverage
• Phase IV Assess Measurement Error
• Compare measurement error in the CPS to the
  National Health Interview Survey (NHIS) by
  linking the NHIS to the MSIS
• Compare measurement error in CPS to state survey
  experiments

12
Continued

• Administrative and survey data processing,
  editing and imputation
• Evaluate how well the CPS edits and imputations
  work at both the micro level and the overall
  macro level
• Evaluate additional state-level Medicaid data
• Survey sample coverage error and survey
  nonresponse bias
• Link the address data from the 7 states to the
  Census Bureaus Master Address File to determine
  sample coverage problems
• Assess whether those addresses with a Medicaid
  enrollee are more likely to not participate in
  Census Bureau surveys

13
Study Conclusions

• We have presented preliminary results that are
  subject to change after further investigation
• At the moment we conclude that survey measurement
  error is playing the most significant role in
  producing the undercount
• Some Medicaid enrollees answer that they have
  other types of coverage and some answer that they
  are uninsured
• The overall goal of the project is to improve the
  CPS for supporting health policy analysis
• Especially refining estimates of the uninsured

14
The Census Bureaus Mandate for Administrative
Records Use

• Title 13, Section 6
• Use administrative records information as
  extensively as possible in lieu of conducting
  direct inquires  
• Census Bureau Strategic Plan
• Reduce reporting burden and minimize cost to
  taxpayer by acquiring and developing high-quality
  data from sources maintained by other government
  and commercial entities

15
Safeguarding Administrative Records at the Census
Bureau

• Consistent Application of Policies
• To ensure that projects have the appropriate
  legal authorization, comply with existing data
  agreements, and provide adequate controls to
  protect confidentiality and privacy
• Administrative Controls
• Numerous levels of approval
• Need-to-know access
• Removal of identifiable information
• Administrative Records Tracking System
• Security and confidentiality training

16
Census Bureau Programs that Use Administrative
Records

• Economic Directorates Business Register
• Intercensal Estimates
• Master Address File
• Small Area Income and Poverty Estimates
• Longitudinal Employer-Household Dynamics
• National Longitudinal Mortality Study
• Current and Periodic Demographic Surveys

17
The Census Bureaus Administrative Records
Program Evolution
Infrastructure investments allow new interagency
collaborations
Projects included AREX 2000 and the 1999 StARS
prototype
Survey launched to gather info on potential AR
files
Race Model Addresses Quality Concerns
Program begins
AR Research staff created
1996
July 1993
1999/2000
2002
2005
Early 1990s
mid 1990s
1999
2001
2004
July 1993
Today
Data Stewardship program begins
AR Test for 2000 Census
Statistical uses of AR conference held
PVS Increases Linking Capacity
Centralized program emerges
18
The Census Bureaus Administrative Records
Infrastructure

• STARS National Files including
• IRS personal tax returns, salary reports, and
  information returns
• Medicare Medicaid
• Indian Health Service
• HUD files (TRACS, MTCS, PIH, and CHUMS)
• Selective Service
• Supplemental Security Income
• Unemployment Insurance Wage Files (selected
  states)
• MAF National Change Of Address File
• Social Security Numident File
• Creation of the Census Numident file
• Look-up file that provides demographic data

19
Current and Emerging Census Bureau Demographic
Applications (1)

• Tested for assigning missing characteristics to
  census records
• Used to assist coverage improvement operations
  target areas requiring follow-up
• Enhanced the decennial Group Quarters frame with
  commercial and state address lists
• Reducing ACS small area variance with
  model-assisted estimation based on AR

20
Current and Emerging Census Bureau Demographic
Applications (2)

• Using integrated data sets to better understand
  the differences between survey and administrative
  data
• Improve survey instrument design, editing,
  imputation, and weighting
• Provide statistics to improve an agencys
  approach to measure program effectiveness
• Provide measures to improve agency
  micro-simulation models
• Identify areas for agency-targeted program
  outreach

21
Current and Emerging Census Bureau Demographic
Applications (3)

• Reacting to disaster and other near-real time
  requirements
• Katrinas effect on the federal statistical
  system and our lack of current response data
  highlighted need
• Acquired the USPS National Change of Address File
  and FEMAs emergency management and flood
  insurance files
• Developing next generation StARS near real-time
  measurements

22
Conclusions

• Integrated data architectures are the future of
  American statistics
• As the demand for data increases and budgets
  decrease data re-use many be the only
  cost-effective option
• Technical and policy related challenges must be
  addressed
• This approach will support evidence-based public
  policy research and decisions.

23
Contact Information

• Ronald C. Prevost
• U.S. Census Bureau
• Washington D.C. 20233-8100
• Email Ronald.C.Prevost_at_Census.Gov
• Phone [phone]
• Cell [phone]