Accuracy in Self-Reported Health Insurance Coverage among Medicaid Enrollees

Abstract

The largest portion of the Medicaid undercount is caused by survey reporting error—that is, Medicaid recipients misreport their enrollment in health insurance coverage surveys. In this study, we sampled known Medicaid enrollees to learn how they respond to health insurance questions and to document correlates of accurate and inaccurate reports. We found that Medicaid enrollees are fairly accurate reporters of insurance status and type of coverage, but some do report being uninsured. Multivariate analyses point to the prominent role of program-related factors in the accuracy of reports. Our findings suggest that the Medicaid undercount should not undermine confidence in survey-based estimates of uninsurance.

Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured

“…Third, using self-reported insurance status introduces recall bias, although previous research suggests that surveys provide reasonable estimates of Medicaid coverage. 38 Lastly, there may also be recall bias for diagnosis of disease, as uninsured people may be less likely to recall a previous diagnosis because of longer intervals between visits to health care providers.…”

Partially Identifying Treatment Effects with an Application to Covering the Uninsured

“…For cases in which validation data are available in the MEPS, Hill (2007Hill ( /2008 finds that private insurance is very accurately reported-most respondents are aware of whether they have private coverage. In contrast, there is evidence of more extensive misreporting of public coverage in surveys Card, Hildreth, Shore-Sheppard 2004;Davern et al 2007). In our restricted sample that excludes the privately insured, the proportion of inaccurate insurance classifications is likely to be higher.…”

“…Reporting errors may not be orthogonal to true insurance status if, for example, better educated respondents are both more likely to be insured and more likely to accurately answer survey questions. Similarly, Card, Hildreth, and Shore-Sheppard (2004) provide evidence that errors in reporting Medicaid coverage vary with family income, which is also a key aspect of Medicaid eligibility.…”

“…For both values of n, we assume that the rate of false positives among those reporting public coverage, PðM Ã ¼ 0jM ¼ 1Þ, does not exceed 0.03. Card, Hildreth, and Shore-Sheppard (2004) estimate that the rate of false positives for Medicaid in the SIPP ranges from 0.01 to 0.03. Like the MEPS, the SIPP is a longitudinal, household survey.…”

“…Significant misreporting has been documented in several popular surveys including the Current Population Survey (CPS), the Survey of Income and Program Participation (SIPP), the Behavioral Risk Factor Surveillance System (BRFSS) survey, the Medical Expenditure Panel Survey (MEPS), and others Card, Hildreth, and Shore-Sheppard 2004;Hill 2007Hill /2008Nelson et al 2000). Estimated error rates, which vary across surveys, have been linked in part to difficulties in recalling past coverage and difficulties reporting the status of other family members (Nelson et al 2000;Pascale 2007).…”