Blog & News
AHIP Presentation 2024: Improving Health Equity Through Better Demographic Data Collection in Medicaid
March 28, 2024:On March 12, 2024, SHADAC Deputy Director Elizabeth Lukanen presented at the AHIP Medicare, Medicaid, Duals & Commercial Markets Forum as a part of the “Improving Health Equity Through Better Data Collection” session series. Elizabeth's presentation focused specifically on demographic data collection in Medicaid.
The conference itself focused on the pressing policy priorities, emerging issues, and regulatory updates for Medicare, Medicaid, Duals, and the commercial market. Topics ranged from panel discussions on filling the gaps in the behavioral health care workforce to presentations on advancing Medicaid Long-Term Services and Supports (LTSS) to the latest information on best practices to collect sexual orientation and gender identity (SOGI) data.
During her session series, Elizabeth shared the stage with other amazing names in public health, including Samantha Artiga, Director for Racial Equity and Health Policy Program at KFF, and Dr. Alex S. Keuroghlian, Associate Professor of Psychiatry at Harvard Medical School and Director of Education & Training at Fenway Health. The session was moderated by Dr. LaShawn McIver, Senior Vice President & Chief Health Equity Officer at AHIP.
Elizabeth’s presentation centered around how better demographic data collection in Medicaid could work towards advancing health equity. She starts by reviewing reasons why data for certain demographics may be of poor quality or missing altogether. She then goes on to discuss issues with demographic data collection for certain populations, like minority racial/ethnic groups, LGBTQ+ individuals, and those with disabilities, and how that can lead to not only data gaps, but also to overall care and access inequities.
Highlighting three states’ equity initiatives, Elizabeth explores how we might work towards improving data collection and utilizing that data to understand inequities and differences between populations served by Medicaid.
“Good data starts with trust,” Lukanen says. If we want to improve demographic data collection, “[we need to] make demographic data collection a priority.”
Make it a priority today – start by reading through the full presentation here or by clicking the image below.
You can also learn more about data collection and advancing health equity with some of the following SHADAC resources:
- Health Equity Measurement: Considerations for Selecting a Benchmark (SHVS Brief)
Publication
SHADAC’s Primary Source of Coverage Hierarchy for American Community Survey (ACS) Estimates on State Health Compare
This updated brief from SHADAC defines a “primary source of coverage hierarchy,” and how and when researchers can use this tool to determine which payer is primary when an individual reports multiple sources of health insurance coverage on the American Community Survey (ACS).
Using a hierarchy provides multiple benefits for researchers, including the ability to ensure that individuals who report having multiple types of coverage are only counted once, reducing the rate of over-reporting for a specific type of coverage, and making coverage estimates more comparable across different surveys. However, SHADAC researchers caution that there is not one specific, singular hierarchy that should always be imposed; rather, there are a multiplicity of possible hierarchies with orders of coverage varying based on the research focus and requirements of each individual analysis (e.g., if a researcher would like to look at a range of coverage over time, or examine coverage for a singular year or specific subpopulations).
When performing national, state, and sub-state analysis of ACS coverage data, SHADAC imposes a particular coverage hierarchy that places respondents into two categories, age 0-18 and age 19 and older, and then ranks possible coverage options—Medicare, Medicaid/CHIP, Employer/Military (TRICARE, VA), Direct purchase, and Uninsured —in descending order for which respondents in each age group will be sorted.
The reason for this separation by age is that for all adults age 19 and older, Medicare is considered the primary source as it is the primary payer for covered medical services. Children age 0-18 are not eligible for Medicare (except in one rare and specific instance) and therefore Employer/Military is considered primary, as many dependents draw this source of coverage from an adult parent or caregiver.
In addition to exploring the different hierarchy possibilities, the brief also walks the user through an example application of SHADAC’s coverage hierarchy on data from the 2022 American Community Survey, and how this affects the rates of reported coverage for each insurance source for the two age groups, both separately and together.
For more on the data produced using SHADAC’s primary source of coverage hierarchy, visit our State Health Compare web tool and explore the “Health Insurance Coverage Type” measure.
Download a PDF of SHADAC’s Coverage Hierarchy for American Community Survey (ACS) Estimates on State Health Compare brief.