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Enrollment Definition
A point-in-time count (similar to ACS)
Medicaid and CHIP (similar to ACS)
Only those eligible for comprehensive benefits (similar
to ACS)
All individuals whether institutionalized or not (similar
to ACS)
Includes those with retroactive eligibility (not like ACS)
Data reported here is from the Performance Indicator
Project
RESEARCH FOCUS
Compare Medicaid enrollment in 2013 and 2014
between the American Community Survey (ACS) and
the Centers for Medicare and Medicaid Services (CMS)
Are there differences in Medicaid enrollment growth
between the ACS and CMS?
Does the gap between ACS and CMS enrollment
change between 2013 and 2014?
Is the gap between ACS and CMS enrollment in 2014
higher in states that saw larger increases in Medicaid
enrollment?
RESULTS
RESULTS
Table 1. Largest percent increases in Medicaid
enrollment from 2013 to 2014
CMS
ACS
State
%
Rank
% Rank
US
Top Ten
Kentucky
Oregon
Nevada
New Mexico
West Virginia
Colorado
Arkansas
Washington
Rhode Island
Maryland
14%
47%
73%
59%
59%
54%
47%
41%
41%
38%
36%
34%
NA
NA
1
2
3
4
5
6
7
8
9
10
8%
22%
28%
35%
33%
11%
24%
22%
11%
21%
28%
14%
NA
NA
4
1
2
15
5
6
14
7
3
10
US
Bottom Ten
Missouri
Nebraska
South Carolina
Virginia
Wyoming
South Dakota
Pennsylvania
Louisiana
Oklahoma
Wisconsin
CMS
% Rank
14%
0.3%
-4%
-2%
-2%
0%
1%
1%
1%
2%
2%
2%
NA
NA
49
48
47
46
45
44
43
42
41
40
ACS
% Rank
8%
0.6%
-3%
1%
6%
1%
10%
-4%
1%
0%
0%
-2%
NA
NA
46
39
24
36
18
47
41
42
43
45
RESULTS
State
US
Top Ten
Kentucky
Oregon
Nevada
New Mexico
West Virginia
Colorado
Arkansas
Washington
Rhode Island
Maryland
2014
%
2014 ADJ.
%
2013
%
-8%
-11%
-1%
-9%
-11%
-19%
-12%
-15%
-8%
-14%
-8%
-9%
-6%
-16%
-20%
-14%
-15%
-27%
-15%
-14%
-20%
-13%
-6%
-15%
-3%
8%
34%
8%
6%
13%
4%
-1%
17%
-2%
-3%
8%
State
US
Bottom Ten
Missouri
Nebraska
South Carolina
Virginia
Wyoming
South Dakota
Pennsylvania
Louisiana
Oklahoma
Wisconsin
2014
%
2014 ADJ.
%
2013
%
-8%
-2%
10%
7%
9%
2%
10%
8%
-10%
-3%
-15%
0%
-6%
0%
0%
4%
9%
1%
9%
-5%
-1%
-1%
-2%
-4%
-3%
-3%
9%
3%
0%
1%
1%
-13%
-10%
-2%
-14%
4%
BACKGROUND
20.0%
10.0% WY
SC
MO
NE SD
VA
-10.0%
0.0%
0.0%
WI
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
KY
80.0%
LA
MD
-10.0%
PA
OK
AR
RI
WA
OR
CO
NM
-20.0%
-30.0%
NV
WV
SUMMARY
In general, in 2014 states with the largest percent
increases in enrollment also have the largest
undercount relative to the CMS
This could be because
New Medicaid enrollees are less likely to know they
are enrolled than people who have been enrolled for
a longer period
The no-wrong-door policy that exchanges followed
may make enrollees think they have private coverage
(QHP)
New Medicaid enrollees may have different
characteristics that are more associated with
reporting error
Retroactive enrollment could be higher in 2014
IMPLICATIONS
Potentially overstating uninsurance rates in 2014
particularly in states with large changes in enrollment
but by how much?
Past research has shown that most misreports are
other types of coverage, not uninsurance (Call 2012,
Boudreaux 2015)
No wrong door could mean these errors are also
mostly between coverage types
After Medicaid enrollment stabilizes this issue could
go away
Our results suggest meaningful state by year variation
in the correspondence of ACS and admin totals which
suggests that caution should be exercised in
interpreting research that compares coverage changes
over time in 2014.