Evaluation of Medicaid Survey Reports in the 2022 ACS Content Test Survey Using Data Linked to CMS Administrative Records

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Working Paper Number: SEHSD-WP2026-18

The 2022 American Community Survey Content Test (ACS CT) researched changes to the health insurance question on the American Community Survey (ACS). The recommendation was to change the format of the question, the wording of some of the response options, and the order of the response options. Of particular interest was how these changes would affect the measurement of Medicaid on the ACS. Historically the ACS has undercounted the number of people with Medicaid compared to enrollment records from the Centers for Medicare and Medicaid Services (CMS). This paper compares reported Medicaid coverage in the previous version of the health insurance question on the ACS (Control) and the newly implemented version of the health insurance question (Test) to enrollment records from CMS. Results show that the two versions of the question perform equally well in the measurement of Medicaid, compared to linked CMS enrollment records.

Page Last Revised - September 9, 2026