Report: States could be missing out on millions of Medicaid dollars due to census undercounts


Emily Boerger


Undercounts from the 2020 Census could mean states are missing out on $552 million in Medicaid reimbursements dollars, according to a report out of the Urban Institute.  

The report estimates an overall 0.5% undercount of the US population but notes that there is considerable variation in who was undercounted and overcounted. Hard-to-count groups, reads the report, include young children, renters, households with noncitizens, and Black and Hispanic/Latinx individuals, which it estimates were undercounted by more than 2.45 and 2.17 percent, respectively.  


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There was also geographic variation with some states – including Alaska, Georgia, Louisiana, Mississippi, New Mexico, New York, and Texas – having likely undercounts greater than one percent of their population.

These undercounts, reasons the report, directly impact federal funding allocations that are funneled into states. Allocations for more than 316 federal programs – including Medicaid – are determined based on census data.

For example, the Urban Institute estimates Texas had a net 1.28 percent undercount.

“Because Texas has such a large population, this means that 377,187 residents in the true population of Texas were not counted in the 2020 Census.”

The report states that if state populations were counted accurately, Texas would receive over $247 million more in federal Medicaid reimbursements over the next decade. This is about one percent of what the state is expected to receive under the official 2020 counts.

Florida saw an estimated 0.95 percent undercount, which equates to almost 207,000 individuals. Among the top 20 largest metropolitan statistical areas, the Miami-Fort Lauderdale-West Palm Beach area saw the greatest undercount at 1.7 percent.

Florida’s undercount equates to an $88 million shortage in Medicaid reimbursements from the federal government, reads the report, or about 0.6 percent of what the state is expected to receive.  

The report also estimates that some state populations had net overcounts, meaning they will receive more Medicaid dollars than if the count was fully accurate.

Minnesota had the largest net overcount at 0.76 percent, estimates the report, which means the state will receive an additional $156 million Medicaid reimbursements.  

The difference in over and under Medicaid reimbursements equals $481 million in additional payments to states.