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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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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Reporting of Indian Health Service Coverage in the American Community Survey
May 2018
Working Paper Number:
carra-2018-04
Response error in surveys affects the quality of data which are relied on for numerous research and policy purposes. We use linked survey and administrative records data to examine reporting of a particular item in the American Community Survey (ACS) - health coverage among American Indians and Alaska Natives (AIANs) through the Indian Health Service (IHS). We compare responses to the IHS portion of the 2014 ACS health insurance question to whether or not individuals are in the 2014 IHS Patient Registration data. We evaluate the extent to which individuals misreport their IHS coverage in the ACS as well as the characteristics associated with misreporting. We also assess whether the ACS estimates of AIANs with IHS coverage represent an undercount. Our results will be of interest to researchers who rely on survey responses in general and specifically the ACS health insurance question. Moreover, our analysis contributes to the literature on using administrative records to measure components of survey error.
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Assimilation and Coverage of the
Foreign-Born Population in Administrative Records
April 2015
Working Paper Number:
carra-2015-02
The U.S. Census Bureau is researching ways to incorporate administrative data in decennial census and survey operations. Critical to this work is an understanding of the coverage of the population by administrative records. Using federal and third party administrative data linked to the American Community Survey (ACS), we evaluate the extent to which administrative records provide data on foreign-born individuals in the ACS and employ multinomial logistic regression techniques to evaluate characteristics of those who are in administrative records relative to those who are not. We find that overall, administrative records provide high coverage of foreign-born individuals in our sample for whom a match can be determined. The odds of being in administrative records are found to be tied to the processes of immigrant assimilation - naturalization, higher English proficiency, educational attainment, and full-time employment are associated with greater odds of being in administrative records. These findings suggest that as immigrants adapt and integrate into U.S. society, they are more likely to be involved in government and commercial processes and programs for which we are including data. We further explore administrative records coverage for the two largest race/ethnic groups in our sample - Hispanic and non-Hispanic single-race Asian foreign born, finding again that characteristics related to assimilation are associated with administrative records coverage for both groups. However, we observe that neighborhood context impacts Hispanics and Asians differently.
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The Measurement of Medicaid Coverage in the SIPP: Evidence from California, 1990-1996
September 2002
Working Paper Number:
CES-02-21
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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Evaluating Race and Hispanic Origin Responses of Medicaid Participants Using Census Data
April 2015
Working Paper Number:
carra-2015-01
Health and health care disparities associated with race or Hispanic origin are complex and continue to challenge researchers and policy makers. With the intention of improving the measurement and monitoring of these disparities, provisions of the Patient Protection and Affordable Care Act (ACA) of 2010 require states to collect, report and analyze data on demographic characteristics of applicants and participants in Medicaid and other federally supported programs. By linking Medicaid records to 2010 Census, American Community Survey, and Census 2000, this new large-scale study examines and documents the extent to which pre-ACA Medicaid administrative records match self-reported race and Hispanic origin in Census data. Linked records allow comparisons between individuals with matching and non-matching race and Hispanic origin data across several demographic, socioeconomic and neighborhood characteristics, such as age, gender, language proficiency, education and Census tract variables. Identification of the groups most likely to have non-matching and missing race and Hispanic origin data in Medicaid relative to Census data can inform strategies to improve the quality of demographic data collected from Medicaid populations.
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Exploring Administrative Records Use for Race and Hispanic Origin Item Non-Response
December 2014
Working Paper Number:
carra-2014-16
Race and Hispanic origin data are required to produce official statistics in the United States. Data collected through the American Community Survey and decennial census address missing data through traditional imputation methods, often relying on information from neighbors. These methods work well if neighbors share similar characteristics, however, the shape and patterns of neighborhoods in the United States are changing. Administrative records may provide more accurate data compared to traditional imputation methods for missing race and Hispanic origin responses. This paper first describes the characteristics of persons with missing demographic data, then assesses the coverage of administrative records data for respondents who do not answer race and Hispanic origin questions in Census data. The paper also discusses the distributional impact of using administrative records race and Hispanic origin data to complete missing responses in a decennial census or survey context.
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The Mortality Risk of Raising Grandchildren in the United States
February 2026
Working Paper Number:
CES-26-13
In the United States, grandparents who live with and provide primary care to their grandchildren have emerged as a particularly vulnerable group since the 1990s. Using confidential data from the U.S. Census Bureau and Social Security Administration, this study linked individuals aged 50 years or older from the 2000 census long-form sample to their death records from 2000'2019 (weighted n = 64,027,000) and examined the longitudinal association between coresident grandparenting status and mortality for non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Asians. We found consistently higher rates of mortality for White coresident grandparents and lower rates for Asian coresident grandparents, regardless of the duration of primary caregiving, compared to their peers without coresident grandchildren. We also found increased risks of mortality among Hispanic long-term primary caregivers but reduced risks among Black short-term primary caregivers, compared to their peers without coresident grandchildren.
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Coverage and Agreement of Administrative Records and 2010 American Community Survey Demographic Data
November 2014
Working Paper Number:
carra-2014-14
The U.S. Census Bureau is researching possible uses of administrative records in decennial census and survey operations. The 2010 Census Match Study and American Community Survey (ACS) Match Study represent recent efforts by the Census Bureau to evaluate the extent to which administrative records provide data on persons and addresses in the 2010 Census and 2010 ACS. The 2010 Census Match Study also examines demographic response data collected in administrative records. Building on this analysis, we match data from the 2010 ACS to federal administrative records and third party data as well as to previous census data and examine administrative records coverage and agreement of ACS age, sex, race, and Hispanic origin responses. We find high levels of coverage and agreement for sex and age responses and variable coverage and agreement across race and Hispanic origin groups. These results are similar to findings from the 2010 Census Match Study.
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The Use of Administrative Records and the American Community Survey to Study the Characteristics of Undercounted Young Children in the 2010 Census
May 2018
Working Paper Number:
carra-2018-05
Children under age five are historically one of the most difficult segments of the population to enumerate in the U.S. decennial census. The persistent undercount of young children is highest among Hispanics and racial minorities. In this study, we link 2010 Census data to administrative records from government and third party data sources, such as Medicaid enrollment data and tenant rental assistance program records from the Department of Housing and Urban Development, to identify differences between children reported and not reported in the 2010 Census. In addition, we link children in administrative records to the American Community Survey to identify various characteristics of households with children under age five who may have been missed in the last census. This research contributes to what is known about the demographic, socioeconomic, and household characteristics of young children undercounted by the census. Our research also informs the potential benefits of using administrative records and surveys to supplement the U.S. Census Bureau child population enumeration efforts in future decennial censuses.
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Receipt of Public and Private Food Assistance Across the Rural-Urban Continuum Before and During the COVID-19 Pandemic: Analysis of Current Population Survey Data
August 2025
Working Paper Number:
CES-25-51
Background: The nutrition safety net in the United States is critical to supporting food security among households in need. Food assistance in the United States includes both government-funded food programs and private community-based providers who distribute food to in need households. The COVID-19 pandemic impacted experiences of food security and use of private and public food assistance resources. However, this may have differed for households residing in urban versus rural areas. We explored receipt of Supplemental Nutrition Assistance Program (SNAP) benefits or food from community-based emergency food providers across a detailed measure of the rural-urban continuum before and during the COVID-19 pandemic.
Methods: We linked restricted use Current Population Survey Food Security Supplement data to census-tract level United States Department of Agriculture Rural-Urban Commuting Area codes to estimate prevalence of self-reported SNAP participation and receipt of emergency food support across temporal (2015-2019 versus 2020-2021) and socio-spatial (urban, large rural city/town, small rural town, or isolated rural town/area) dimensions. We report prevalences as point estimates with 95% confidence intervals, all weighted for national representation.
Results:
The weighted prevalence of self-reported SNAP participation was 8.9% (8.7-9.2%) in 2015-2019 and 9.1% (8.5-9.5%) in 2020-2021 in urban areas, 11.4% (10.8-12.2%) in 2015-2019 and 11.6% (10.5-12.9%) in 2020-2021 in large rural towns/cities, 13.4% (12.3-14.6%) in 2015-2019 and 12.3% (10.5-14.5%) in 2020-2021 in small rural towns, and 9.7% (8.6-10.9%) in 2015-2019 and 10.9% (8.8-13.4% )in 2020-2021 isolated rural towns. The weighted prevalence of self-reported receipt of emergency food was 4.9% (4.8-5.1%) in 2015-2019 and 6.2% (5.8-6.5%) in 2020-2021 in urban areas, 6.8% (6.2-7.4%) in 2015-2019 and 7.6% (6.6-8.6%) in 2020-2021 in large rural towns/cities, 8.1% (7.3-9.1%) in 2015-2019 and 7.1% (5.7-8.8%) in 2020-2021 in small rural towns, and 6.8% (5.9-7.7%) in 2015-2019 and 8.5% (6.7-10.6%) in 2020-2021 isolated rural towns.
Conclusion: Households in rural communities use public and private food assistance at higher rates than urban areas, but there is variation across communities depending on the level of rurality.
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