Analysis of Children's Health Insurance Patterns: Findings from the SIPP. Undercount of Medicaid Children

05/12/1999

Crude comparisons of CPS estimates and Medicaid program statistics suggest that the CPS underestimates by a substantial margin the number of Medicaid enrollees for the population as a whole. Researchers at the Urban Institute have made a practice of adjusting their estimates of uninsured children and adults to compensate for what they interpret as incomplete reporting of Medicaid coverage by survey households. The effect of these adjustments is sizable. When applied to data for 1994 and 1995 they lowered the estimated number of uninsured children from 10.6 million to 7.6 million and reduced the estimated number of Medicaid-eligible uninsured children from 4.5 million to 1.6 million (Ullman et al. 1998).

Evaluating the Medicaid coverage of the SIPP or the CPS is, in fact, both difficult and problematic. It is difficult because the program administrative statistics are very limited, which complicates the task of creating administrative and survey estimates that apply to the same universe. One major problem, discussed in subsequent sections, is that survey data generally represent points in time while federal administrative data include those covered by Medicaid at any time throughout the year. Beyond that, the age categories for which Medicaid statistics are reported do not lend themselves to identifying children in the way that they are commonly defined in policy analyses--that is, under 19 or under 18. Part of the problem is that the national statistics are assembled from reports submitted by the states, and the state data differ in quality and in some of the conventions that they apply. In 1993 more than half of the state reports were submitted in hard-copy, giving HCFA(now known as CMS) no flexibility to generate additional tabulations--with alternative age categories, for exmple.

Evaluating Medicaid coverage is also problematic. Even if the program data and survey data could be matched with respect to universe, simply comparing them would not tell the whole story. Because the Medicaid statistics come from separate state systems they are not unduplicated across states. If a child moves from one state to another and is enrolled in Medicaid in both states during the same fiscal year, the child will be counted in both states' statistics. In a survey, of course, this same child would be represented as a Medicaid recipient in only one state. Another factor confounding the comparison of survey and administrative estimates is the potential misreporting of Medicaid coverage as something else. Survey respondents may not be fully aware that the source of their medical coverage is Medicaid. States have developed alternative names for their programs and issued health insurance cards that resemble those issued by private insurers, perhaps persuading some Medicaid enrollees that their coverage is from a private source. Finally, a number of states run affiliated programs that do not receive federal reimbursement and whose enrollees, therefore, are not counted in the Medicaid program statistics. If such persons report their coverage in surveys as Medicaid, as seems likely, or if the Census Bureau interprets it and edits it as such, then the survey estimates of Medicaid coverage will include persons who are not counted in the administrative totals.

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