Full Citation

Title: Medicaid expansion and the Medicaid undercount in the American Community Survey

Citation Type: Journal Article

Publication Year: 2019

ISBN:

ISSN: 0017-9124

DOI: 10.1111/1475-6773.13213

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Abstract: Objective: To measure discordance between aggregate estimates of means-tested coverage from the American Community Survey (ACS) and administrative counts and examine the association of discordance with ACA Medicaid expansion. Data Sources: 2010-2016 ACS and counts of Medicaid and Children's Health Insurance Program enrollment from the Centers for Medicare & Medicaid Services. Study Design: State-by-year counts of means-tested coverage from the ACS were compared to administrative counts using percentage differences. Discordance was compared for states that did and did not adopt expansion using difference-in-differences. We then contrasted the effect of expansion on means-tested coverage estimated from the ACS with results from administrative data. Data Collection/Extraction: Survey and administrative data. Principal Findings: One year before expansion there was a 0.8 and 4 percent overcount in expansion and nonexpansion states, respectively. By 2016, there was a 10.64 percent undercount in expansion states vs a 0.02 percent undercount in nonexpansion states. The ACS suggests that expansion increased means-tested coverage in the full population by three percentage points, relative to five percentage points suggested by administrative records. Conclusions: Discordance between the ACS and administrative records has increased over time. The ACS underestimates the impact of Medicaid expansion, relative to administrative counts.

Url: https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.13213

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Authors: Boudreaux, Michel; Noon, James M.; Fried, Brett; Pascale, Joanne

Periodical (Full): Health Services Research

Issue: 6

Volume: 54

Pages: 1263-1272

Data Collections: IPUMS USA

Topics: Health

Countries: United States