Medicare Has Problems With Seeing Race and Ethnicity: Inspector General's Office

The Medicare program has better data on whether enrollees think of themselves as white or Black than on whether they identify themselves as having another race or ethnicity, federal officials said earlier this week.

Because the Medicare program is so big, and researchers and policymakers watch it closely to understand health care trends, the race and ethnicity information gap could hurt efforts to analyze and improve the quality of care, the officials warned.

The officials are staff members at the Department of Health and Human Services Office of Inspector General. HHS office investigators summarized their findings in a new report.

What It Means

This report deals with a specific type of problem the government has with collecting and managing basic information about your clients.

As more of your clients age into eligibility for Medicare and Social Security, you may find that their most pressing financial concerns have less to do with stock market volatility than with how to get the government to correct basic errors related to their name, race or ethnicity, address, birthdate and other basic information.

The advisors who have talented, energetic identity fixers on staff, or who can connect clients with high-performing identity fixer services, may enjoy a high client referral rate.

The new report also reflects the reality that many efforts to break health and financial market data down by race and ethnicity may suffer from methodological problems. Advisors using that data should pay close attention to any methodology and limitations sections available in the full reports.

The Report

Medicare is a federal program that provides health coverage for 66 million people, including people ages 65 and older, people under 65 with severe disabilities, and people under 65 with severe kidney disease.

The Department of Health and Human Services oversees the Centers for Medicare & Medicaid Services, the federal agency that runs Medicare and Medicaid.

The same inspector general’s office team keeps tabs on activities at Medicare and at other HHS programs.

The Medicare program relies on the Social Security Administration to help it with enrollment.

An HHS inspector general’s office team led by Rachel Bryan conducted the race and ethnicity data study by focusing on Medicare enrollees who live in nursing homes.

The team compared the race and ethnicity information in the Medicare enrollment database with the information the enrollees reported to the nursing homes.

“Self-reported race and ethnicity data are considered the most reliable,” according to the investigation team.

The Results

When the investigation team calculated the conflict rates between race and ethnicity information in the Medicare enrollment database and in the nursing home records, here’s how the size of the conflict rates for enrollees in various groups looked:

• Black: 3%.
• White: 4%.
• Hispanic: 13%.
• Asian or Pacific Islander: 24%.
• American Indian or Alaska Native: 35%.

The Investigators’ View

The investigation team noted in the report that the Medicare enrollment database has obvious race and ethnicity limitations.

One is that Medicare has data on only a few race and ethnicity categories, and another is that it’s missing race and ethnicity data for 3.3 million beneficiaries, officials said.

Before 1980, officials said, Social Security card applicants could choose from only three race and ethnicity categories: white, Black and other.

Social Security classified applicants who skipped the question as “unknown.”

Because of those limitations, Medicare shows that only 2.5% of its enrollees are Asian or Pacific Islander, and 3% are Hispanic, even though surveys suggest that 5.1% of U.S. residents over 65 are Asian or Pacific Islander, and 8% are Hispanic.

The completeness of the Medicare race and ethnicity data based on Social Security information will decrease over time, because the Social Security Administration stopped routinely collecting race and ethnicity information in 1989, officials said.

The investigation team is recommending that Medicare managers consider asking people to provide race and ethnicity information when they sign up for Medicare, or by conducting surveys.

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