This paper studies the accuracy of reported Medicaid coverage in the Survey of Income and Program Participation (SIPP) using a unique data set formed by matching SIPP survey responses to administrative records from the State of California. Overall, we estimate that the SIPP underestimates Medicaid coverage in the California populaton by about 10 percent. Among SIPP respondents who can be matched to administrative records, we estimate that the probability someone reports Medicaid coverage in a month when they are actually covered is around 85 percent. The corresponding probability for low-income children is even higher ' at least 90 percent. These estimates suggest that the SIPP provides reasonably accurate coverage reports for those who are actually in the Medicaid system. On the other hand, our estimate of the false positive rate (the rate of reported coverage for those who are not covered in the administrative records) is relatively high: 2.5 percent for the sample as a whole, and up to 20 percent for poor children. Some of this is due to errors in the recording of Social Security numbers in the administrative system, rather than to problems in the SIPP.
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Response Error & the Medicaid undercount in the CPS
December 2016
Working Paper Number:
carra-2016-11
The Current Population Survey Annual Social and Economic Supplement (CPS ASEC) is an important source for estimates of the uninsured population. Previous research has shown that survey estimates produce an undercount of beneficiaries compared to Medicaid enrollment records. We extend past work by examining the Medicaid undercount in the 2007-2011 CPS ASEC compared to enrollment data from the Medicaid Statistical Information System for calendar years 2006-2010. By linking individuals across datasets, we analyze two types of response error regarding Medicaid enrollment - false negative error and false positive error. We use regression analysis to identify factors associated with these two types of response error in the 2011 CPS ASEC. We find that the Medicaid undercount was between 22 and 31 percent from 2007 to 2011. In 2011, the false negative rate was 40 percent, and 27 percent of Medicaid reports in CPS ASEC were false positives. False negative error is associated with the duration of enrollment in Medicaid, enrollment in Medicare and private insurance, and Medicaid enrollment in the survey year. False positive error is associated with enrollment in Medicare and shared Medicaid coverage in the household. We discuss implications for survey reports of health insurance coverage and for estimating the uninsured population.
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The Long-Term Effects of Income for At-Risk Infants: Evidence from Supplemental Security Income
March 2024
Working Paper Number:
CES-24-10
This paper examines whether a generous cash intervention early in life can "undo" some of the long-term disadvantage associated with poor health at birth. We use new linkages between several large-scale administrative datasets to examine the short-, medium-, and long-term effects of providing low-income families with low birthweight infants support through the Supplemental Security Income (SSI) program. This program uses a birthweight cutoff at 1200 grams to determine eligibility. We find that families of infants born just below this cutoff experience a large increase in cash benefits totaling about 27%of family income in the first three years of the infant's life. These cash benefits persist at lower amounts through age 10. Eligible infants also experience a small but statistically significant increase in Medicaid enrollment during childhood. We examine whether this support affects health care use and mortality in infancy, educational performance in high school, post-secondary school attendance and college degree attainment, and earnings, public assistance use, and mortality in young adulthood for all infants born in California to low-income families whose birthweight puts them near the cutoff. We also examine whether these payments had spillover effects onto the older siblings of these infants who may have also benefited from the increase in family resources. Despite the comprehensive nature of this early life intervention, we detect no improvements in any of the study outcomes, nor do we find improvements among the older siblings of these infants. These null effects persist across several subgroups and alternative model specifications, and, for some outcomes, our estimates are precise enough to rule out published estimates of the effect of early life cash transfers in other settings.
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Covering Undocumented Immigrants: The Effects of a Large-Scale Prenatal Care Intervention
August 2022
Working Paper Number:
CES-22-28
Undocumented immigrants are ineligible for public insurance coverage for prenatal care in most states, despite their children representing a large fraction of births and having U.S. citizenship. In this paper, we examine a policy that expanded Medicaid pregnancy coverage to undocumented immigrants. Using a novel dataset that links California birth records to Census surveys, we identify siblings born to immigrant mothers before and after the policy. Implementing a mothers' fixed effects design, we find that the policy increased coverage for and use of prenatal care among pregnant immigrant women, and increased average gestation length and birth weight among their children.
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Potential Bias When Using Administrative Data to Measure the Family Income of School-Aged Children
January 2025
Working Paper Number:
CES-25-03
Researchers and practitioners increasingly rely on administrative data sources to measure family income. However, administrative data sources are often incomplete in their coverage of the population, giving rise to potential bias in family income measures, particularly if coverage deficiencies are not well understood. We focus on the school-aged child population, due to its particular import to research and policy, and because of the unique challenges of linking children to family income information. We find that two of the most significant administrative sources of family income information that permit linking of children and parents'IRS Form 1040 and SNAP participation records'usefully complement each other, potentially reducing coverage bias when used together. In a case study considering how best to measure economic disadvantage rates in the public school student population, we demonstrate the sensitivity of family income statistics to assumptions about individuals who do not appear in administrative data sources.
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Long-Run Earnings Volatility and Health Insurance Coverage: Evidence from the SIPP Gold Standard File
October 2011
Working Paper Number:
CES-11-35
Despite the notable increase in earnings volatility and the attention paid to the growing ranks of the uninsured, the relationship between career earnings and short- and mediumrun health insurance status has been ignored due to a lack of data. I use a new dataset, the SIPP Gold Standard File, that merges health insurance status and demographics from the Survey of Income and Program Participation with career earnings records from the Social Security Administration (SSA) and the Internal Revenue Service (IRS) to examine the relationship between long-run family earnings volatility and health insurance coverage. I find that more volatile career earnings are associated with an increased probability of experiencing an uninsured episode, with larger effects for men, young workers, and the unmarried. These findings are consistent with the 'scarring' literature, and suggest the importance of safety-net measures for job losses and health insurance coverage.
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An Analysis of Sample Selection and the Reliability of Using Short-term Earnings Averages in SIPP-SSA Matched Data
December 2011
Working Paper Number:
CES-11-39
In this paper, we document the extent to which the sample of the Survey of Income and Program Participation that is matched to the Social Security Administration's administrative earnings records is nationally representative. We conclude that the match bias is small, so selection is not a serious concern. The matched sample over-represents individuals who are wealthy, who have financial assets or who have received a government-transfer and under-represents individuals who attrited from the SIPP. We use this matched sample to examine the relationship between short-term averages of earnings from the SIPP earnings and average lifetime earnings from the administrative records. Our estimates suggest that using short averages of earnings may understate the effects of permanent income on particular outcomes of interest.
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Longitudinal analysis of SSN response on SIPP 1990-1993 panel
September 2000
Working Paper Number:
tp-2000-01
This document describes the analysis of the SIPP-SSN match quality, and the file resulting for that analysis as distributable to the Census RDCs.
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Earnings Mobility in the US: A New Look at Intergenerational Inequality
May 2002
Working Paper Number:
CES-02-11
This study uses a new data set that contains the Social Security earnings histories of parents and children in the 1984 Survey of Income and Program Participation, to measure the intergenerational elasticity in earnings in the United States. Earlier studies that found an intergenerational elasticity of 0.4 have typically used only up to five-year averages of fathers' earnings to measure fathers' permanent earnings. However, dynamic earnings models that allow for serial correlation in transitory shocks to earnings imply that using such a short time span may lead to estimates that are biased down by nearly 30 percent. Indeed, by using many more years of fathers' earnings than earlier studies, the intergenerational elasticity between fathers and sons is estimated to be around 0.6 implying significantly less mobility in the U.S. than previous research indicated. The elasticity in earnings between fathers and daughters is of a similar magnitude. The evidence also suggests that family income has an even larger effect than fathers' earnings on children's future labor market success. The elasticity of earnings is higher for families with low net worth, offering some empirical support for theoretical models that predict differences due to borrowing constraints. Some evidence of a higher elasticity among blacks is found but the results are not conclusive.
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Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data
November 2022
Working Paper Number:
CES-22-55
We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary nonmonotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution---who have the worst birth outcomes---have a death rate that is half that of infants of parents in the bottom ventile. When studying maternal health, we find a similar pattern of non-monotonicity between income and severe maternal morbidity, and a monotonic and decreasing relationship between income and maternal mortality. At the same time, these disparities by parental income are small when compared to racial disparities, and we observe virtually no convergence in health outcomes across racial and ethnic groups as income rises. Indeed, infant and maternal health in Black families at the top of the income distribution is markedly worse than that of white families at the bottom of the income distribution. Lastly, we benchmark the health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution.
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Medicare Coverage and Reporting
December 2016
Working Paper Number:
carra-2016-12
Medicare coverage of the older population in the United States is widely recognized as being nearly universal. Recent statistics from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) indicate that 93 percent of individuals aged 65 and older were covered by Medicare in 2013. Those without Medicare include those who are not eligible for the public health program, though the CPS ASEC estimate may also be impacted by misreporting. Using linked data from the CPS ASEC and Medicare Enrollment Database (i.e., the Medicare administrative data), we estimate the extent to which individuals misreport their Medicare coverage. We focus on those who report having Medicare but are not enrolled (false positives) and those who do not report having Medicare but are enrolled (false negatives). We use regression analyses to evaluate factors associated with both types of misreporting including socioeconomic, demographic, and household characteristics. We then provide estimates of the implied Medicare-covered, insured, and uninsured older population, taking into account misreporting in the CPS ASEC. We find an undercount in the CPS ASEC estimates of the Medicare covered population of 4.5 percent. This misreporting is not random - characteristics associated with misreporting include citizenship status, year of entry, labor force participation, Medicare coverage of others in the household, disability status, and imputation of Medicare responses. When we adjust the CPS ASEC estimates to account for misreporting, Medicare coverage of the population aged 65 and older increases from 93.4 percent to 95.6 percent while the uninsured rate decreases from 1.4 percent to 1.3 percent.
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