Federal Survey Sample Size Analysis: Disability, Language, and Sexual Orientation and Gender Identity
The Medicaid and CHIP Payment and Access Commission contracted with the State Health Access Data Assistance Center (SHADAC) to conduct a review and sample size analysis of 13 federal population health surveys to assess the quality and availability of data for certain populations facing health inequities, including people with disabilities, language access needs, and people who indicate their sexual orientation or gender identity (SOGI). This brief provides an overview of each federal survey and identifies which surveys included questions about disability, primary language, limited English proficiency (LEP), and sexual orientation and gender identity (SOGI). Below is an overview table of the Federal surveys included in this analysis.
|Federal Survey||Periodicity||Target Population||States, DC, and Territories Represented||Most Recent Data Year||Total Population Unweighted Sample Size||Total Unweighted Sample Size for Medicaid 1|
|ACS||Annual||Civilian, non-institutionalized U.S. population||50 states, D.C., Puerto Rico||2021||3,252,599||434,900|
|BRFSS||Annual||U.S. adults > 18 years||49 states (no Florida in 2021), D.C., Guam, Puerto Rico, Virgin Islands||2021||438,693||50,306|
|CPS||Annual||Civilian, non-institutionalized U.S. population||50 states, D.C.||2022||152,732||24,155|
|HPS||Panel||U.S. adults > 18 years||50 states, D.C.||2023||59,290||2,764|
|MEPS-HC2||Panel||Civilian, non-institutionalized U.S. population||No state estimates||2020||27,805||6,504|
|MCBS3||Annual||All individuals enrolled in Medicare||No state estimates||2020||13,916||2,593|
|NAMCAHPS4||Fielded once||Adults enrolled in Medicaid||50 states, D.C.||2014||272,679||272,679|
|NHANES||Periodic||Civilian, non-institutionalized U.S. population||No state estimates||20205||9,254||2,841|
|NHIS||Annual||Civilian, non-institutionalized U.S. population||50 states, D.C. when two years combined in the RDC||2022||35,115||4,918|
|NSCH6||Annual||U.S. children < 18 years||50 states, D.C. when two years combined||2021||50,892||11,259|
|NSDUH||Annual||Civilian, non-institutionalized U.S. population, age 12 +||No state estimates||2021||58,034||11,008|
|PRAMS||Annual||Pregnant women in 47 states, D.C., and Puerto Rico||See target population||2021||NA||NA|
|SIPP7||Panel||Civilian, non-institutionalized U.S. population||50 states, D.C.||2022||40,510||5,835|
1 Unless otherwise noted, where relevant, Medicaid was defined using the typical MACPAC hierarchy:
(1) Medicare; (2) Private with no Medicare; (3) Medicaid with no Medicare or private; (4) Other type of insurance with no Medicare or private; (5) Uninsured all year
2 Medicaid coverage was defined based on the most recent date of data collection (e.g., December).
3 MCBS data uses “full year dual” to define Medicaid, meaning people who were enrolled in Medicare and Medicaid all year.
4 NAMCAHPS limited to adults enrolled in Medicaid.
5 Sample size analysis conducted using 2017-2018 file, because of pandemic impacts on data collection in 2020.
6 The NSCH includes three categories of children’s coverage (public, private, uninsured); we code children in public coverage as having Medicaid, because Medicare is much less common among children.
7 SIPP data uses the annual coverage variables to define Medicaid.
Source: SHADAC analysis of federal survey data.
The findings show that the majority of surveys include questions to identify individuals with a functional disability. Still, fewer than half of these surveys include questions about intellectual disability, serious mental illness, primary language, LEP, and SOGI. Of the surveys that include these questions, the majority have a sufficient sample for reporting about Medicaid-covered individuals for each demographic group.