How Census Bureau Data is Used by Federal Health Care Programs

March 19, 2020

Note: This is the third in a series of five The Valued Voice articles about the U.S. Census and why it’s important for health care. 
   
Starting last week, the U.S. Census Bureau began mailing letters to households. The letters contain unique identifying codes. Entering the code in the U.S. Census Bureau website enables the household to complete the census online. Households who do not complete the census online will receive a paper copy of the census in the mail.  
 
If you have chosen to respond online and reviewed the census form, you will quickly realize that the decennial numbers, on their own, cannot guide the distribution of federal funds. Therefore, Congress has authorized a series of more current and descriptive datasets derived from the Decennial Census. This article focuses on major federal health care programs that use measures which are derived from the Census:
 
Medicaid Funding Formula:  The costs of Medicaid benefits are shared between the federal government and each state depending on a state’s federal medical assistance percentage (FMAP). The FMAP, which is recalculated each year, is based on each state’s per capita personal income over the most recent three calendar years compared to the national average for those years. Per capita personal income data used in the FMAP calculation are from two separable data streams, income and population, which are calculated respectively by the Bureau of Economic Analysis (BEA) and the Census Bureau. BEA combines the two streams to produce the per capita income estimates. Between the decennial censuses, population data used for the state per capita estimates are those generated by annual estimates produced each year from the July Current Population Survey (CPS), a Census Bureau tool.
 
Medicare Physician Fee Schedule: Fee-for-service Medicare payments to practitioners are based on the Physician Fee Schedule (PFS). Each of the PFS’ 7,000 distinct codes has an assigned number of relative value units (RVUs) that represents the cost of resources required to provide a particular procedure or service relative to the resources associated with other procedures or services. Geographic adjustments are made to the RVUs using the Geographic Practice Cost Index (GPCI). The GPCI is derived in part from the American Community Survey, which is a Census Bureau tool. The ACS provides one-year estimates of economic characteristics, including wages. ACS data include both employed physicians and self-employed physicians.
 
Health Professions Shortage Areas (HPSAs): HPSAs are designated by the Health Resources Services Administration (HRSA). HRSA designates HPSAs using standard national data sets and if applicable, supplemental data provided by the states. Demographic data used to determine HPSAs comes from the U.S. Census Bureau. Other data sources include National Provider Identifier (NPI) data and The Centers for Disease Control and Prevention (CDC) for national vital statistics.
 
Medically Underserved Areas/Populations (MUAs/MUPs): MUAs and MUPs are designated by HRSA. MUAs and MUPs identify geographic areas and populations with a lack of access to primary care services. HRSA assigns a weighted value to an area or population’s performance on four demographic and health indicators: provider per 1,000 population ratios; percent of population at 100% of the Federal Poverty Level (FPL); percent of population age 65 and over; and infant mortality rate. The percent of population age 65 and over comes directly from the Census. The other indicators are from census-derived data sets.
 
Rural Health Clinics: Governors may designate areas of their state as shortage areas specifically for the purpose of Rural Health Clinic (RHC) certification. These areas must meet specific criteria. The service area must meet several high-need health indicators, one of which is what percent of population age 65 and older is higher than the state average, derived directly from the Census. Other indicators are from census-derived data sets.
 
Next week, The Valued Voice will provide information on hard-to-count census areas in Wisconsin, and how health care providers can encourage census participation. For questions regarding the U.S. Census and health care, contact WHA Vice President of Policy Laura Rose

This story originally appeared in the March 19, 2020 edition of WHA Newsletter