Cross-Agency Collaboration in the Rapid 

Development of COVID-19 Questionnaire Items 

for the Medicare Current Beneficiary Survey 

(MCBS)

FCSM Conference

November 2021

Andrea Mayfield, NORC at the University of Chicago

Kylie Carpenter, NORC at the University of Chicago

Rachel Carnahan, NORC at the University of Chicago

Elise Comperchio, NORC at the University of Chicago

Felicia LeClere, NORC at the University of Chicago

The opinions and views expressed in this work are those of the 

authors. No official endorsement by the Department of Health and Human 

Services or the Centers for Medicare & Medicaid Services is intended or 

should be inferred.
Overview

01 Impact of COVID-19 on the MCBS

02 Collaborative Process for Designing and 

Testing Items

03 Data Products and Findings from the MCBS 

COVID-19 Community Supplements
Impact of COVID-19 on the MCBS
BACKGROUND : MEDICARE CURRENT BENEFICIARY SURVEY (MCBS) 4

The Medicare Current Beneficiary Survey (MCBS) is a continuous, 

multi-purpose longitudinal survey.

• The MCBS represents the population of Medicare beneficiaries aged 65 and over and 

beneficiaries aged 64 and under with certain disabling conditions living in the United 

States. 

• The MCBS collects data in two main components: 

– Community: Survey of beneficiaries residing in non-institutional, residential settings

– Facility: Survey of beneficiaries residing in facilities such as long-term care nursing homes

• The MCBS serves as the leading source of information on the Medicare program and 

its impact on beneficiaries, including health care utilization, barriers to care, health 

care expenditures, and physical, emotional, and financial well-being. 
BACKGROUND : COVID-19 PANDEMIC 5

Given the rapidly changing nature of the pandemic, there was an urgent 

need for data to shed light on its impact on the Medicare population. 

• On January 31, 2020, the Secretary of the Department of Health and Human 

Services (HHS) determined that a Public Health Emergency (PHE) existed for the 

United States to aid the nation’s health care community in responding to COVID-19.

• Older people and people of all ages with severe chronic medical conditions — like 

heart disease, lung disease and diabetes, for example — seemed to be at higher 

risk of developing serious COVID-19 illness.1

• By using the MCBS, CMS was uniquely positioned to collect timely and vital 

information on how the pandemic was impacting the lives of Medicare 

beneficiaries.

1

Public Health Emergency Declarationsヮ. U. S. Department of Health & Human Services. Last reviewed September 3, 2021. https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx.
Collaborative Process for Designing and 

Testing Items
COLLABORATIVE PROCESS: OVERVIEW 7

CMS and NORC implemented three COVID-19 Community Supplements 

starting in Summer 2020.

• Rather than modify the main MCBS instruments, stand alone supplemental surveys were 

developed to get into the field as quickly as possible. 

• These rapid response surveys asked about topics such as preventive care, forgone care, 

availability of telemedicine services, and impact to beneficiary well-being.

• Content such as COVID-19 vaccine utilization was updated as the pandemic evolved to 

meet emerging data needs.

• Starting in Summer 2021, the COVID-19 Supplement content was incorporated into the 

main MCBS for subsequent interviews as appropriate.
COLLABORATIVE PROCESS: MCBS COVID-19 SUMMER 2020 SUPPLEMENT TOPICS BY SOURCE 8

Incorporating items from other surveys facilitated rapid development of 

the first MCBS COVID-19 Community Supplement in Summer 2020. 

Source Adapted From Content Area

American Community Survey (ACS) Access to computers and internet

National Center for Health Statistics Research and 

Development Survey (NCHS RANDS)

Ability to access basic needs during the 

pandemic

Availability and use of telemedicine

Autoimmune disease prevalence

COVID-19 care

Forgone health care as a result of the 

pandemic

Impact to financial and mental health

COVID-19 preventive measures

Public health guidance

NCHS RANDS and National Health Interview Survey (NHIS) Utilization of COVID-19 testing

March 2020 Associated Press (AP)-NORC Center Poll Sources of COVID-19 information

March 2020 AP-NORC Center Poll/

University of California Irvine’s COVID-19 Outbreak Study

Knowledge and perceptions of COVID-19
COLLABORATIVE PROCESS: MCBS COVID-19 SUMMER 2020 SUPPLEMENT TEST 9

NORC conducted a field test of the MCBS COVID-19 Community 

Supplement in Summer 2020 under the MCBS Generic Clearance.

• The field test was conducted at 

approximately the same time as testing 

of similar COVID-19 items by other 

agencies, such as NCHS

• Office of Management and Budget 

(OMB) approved the field test under the 

MCBS Generic Clearance (0938-1275) on 

May 7, 2020

• Goal was to assess administration of 

standalone design in parallel with main 

MCBS data collection (never done 

before)

Data Collection

11,114 completes

78.9% response rate

Sample

Existing MCBS sampled beneficiaries who were continuously 

enrolled in Medicare from the beginning of 2020 and were alive 

and living in the community, eligible for and enrolled in 

Medicare at the time of their interview in Summer 2020

Questionnaire

15-minute standalone telephone survey

COVID-19 Summer 2020 Supplement Test

Field Period 

June 10 to July 15, 2020

Simultaneous to main MCBS data collection
COLLABORATIVE PROCESS : COVID-19 FALL 2020 SUPPLEMENT 10

Based on the success of the Summer 2020 field test, CMS 

requested emergency OMB clearance to conduct the COVID-19 Fall 

2020 Community Supplement.

• Strong item performance and data collection results from the Summer 2020 test laid the 

groundwork for requesting OMB Emergency Clearance (0938-1379) to use the same 

standalone survey design in Fall 2020. 

• CMS collaborated with stakeholders to update items in the COVID-19 Fall 2020 Community 

Supplement to remove outdated topics and measure new areas of interest. 

New Items Removed Items

COVID-19 testing (i.e., wait time for test results, out-ofpocket cost of testing)Lack of access to COVID-19 tests

Likelihood of getting a COVID-19 vaccine (items drafted by 

Centers for Disease Control and Prevention (CDC))
COLLABORATIVE PROCESS : COVID-19 FALL 2020 SUPPLEMENT 11

During review of the emergency request, OMB facilitated further crossagency collaboration. 

Source Adapted From Content Area*

ACS Access to computers and internet

NCHS RANDS

Ability to access basic needs during the pandemic

Availability and use of telemedicine

Autoimmune disease prevalence

COVID-19 care

Forgone health care as a result of the pandemic

Impact to financial and mental health

COVID-19 preventive measures

Public health guidance

NCHS RANDS and NHIS Utilization of COVID-19 testing

March 2020 AP-NORC Center Poll Sources of COVID-19 information

March 2020 AP-NORC Center Poll/

University of California Irvine’s COVID-19 Outbreak Study

Knowledge and perceptions of COVID-19

CDC Presumptive vaccine uptake (new topic in Fall 2020!)

• OMB requested that CMS realign the MCBS COVID-19 Fall 2020 Community Supplement with 

NCHS RANDS and NHIS COVID-19 items, which had been recently tested and revised.

*Content areas revised during the OMB review process to realign with other federal surveys are highlighted in orange. 
COLLABORATIVE PROCESS: SUBSEQUENT SUPPLEMENTS 12

CMS revised the MCBS Clearance (0938-0568) to continue fielding 

COVID-19 items as part of the MCBS in 2021 and beyond. 

CMS worked with CDC to add items about COVID-19 vaccine utilization starting in Winter 2021.

Emergency OMB Clearance

(0938-1379)

COVID-19 Fall 2020 

Community Supplement

Main MCBS Clearance 

(0938-0568)

Summer 2021 Community 

Questionnaire 

• Fielded Oct. 5 to Nov. 15, 2020 

• 9,686 completed interviews

• Response rate: 72.6%

• Fielded March 1 to April 25, 2021

• 11,107 completed interviews

• Response rate: 79.6%

Fall 2021 Community 

Questionnaire 

• Starting in Summer 2021, certain COVID-19 

Supplement items were incorporated into the main 

MCBS for subsequent interviews.

Integration of COVID-19 Items into 

Main Community Questionnaire

COVID-19 Winter 2021 

Community Supplement
COLLABORATIVE PROCESS: TIMELINE 13

This process allowed CMS and NORC to field three Supplements in a 12-

month period, creating an opportunity to track the course of the pandemic.

April 

2020

May 

2020

June 

2020

July 

2020

Aug 

2020

Sept 

2020

CMS developed the 

COVID-19 Summer 

2020 Supplement

COVID-19 

Summer 

2020 

Supplement 

Field Test

COVID-19 

Fall 2020 

Supplement

Emergency 

Clearance 

OMB 

Approval 

(0938-1379)

Oct 

2020

Dec 

2020

Nov 

2020

Jan 

2021

Feb 

2021

March 

2021

April 

2021

May 

2021

June 

2021

Generic 

Clearance 

OMB 

Approval 

(0938-1275)

COVID-19 

Winter 2021 

Supplement

Main MCBS Clearance OMB Approval 

(0938-0568)

Collaboration points between CMS and other federal agencies

Date of data release (color coded by Supplement)

COVID-19 Items 

Fielded in Main 

Summer 2021 

Questionnaire
Data Products and Findings from the 

MCBS COVID-19 Community 

Supplements
DATA PRODUCTS: ACCESSING COVID-19 DATA AND ESTIMATES 15

COVID-19 PUFs: • https://www.cms.gov/Research-Statistics-Data-and

-

Systems/Downloadable-Public-Use-Files/MCBS-Public-Use-File

Data Snapshots: • Summer 2020 Supplement: https://www.cms.gov/medicare-currentbeneficiary-survey-summer-2020-covid-19-data-snapshot • Fall 2020 Supplement: https://www.cms.gov/research-statistics-datasystems/mcbs-public-use-file/medicare-current-beneficiary-survey-fall2020-covid-19-data-snapshot • Winter 2021 Supplement: 

https://www.cms.gov/files/document/medicare-current-beneficiarysurvey-covid-19-data-snapshot-infographic-winter-2021.pdf

Public Use Files (PUF) and Data 

Snapshots were publicly released two 

months after the close of data 

collection for each Supplement.
MCBS COVID-19 COMMUNITY SUPPLEMENT : RESULTS – SUMMER 2020 TO WINTER 2021 SUPPLEMENTS 16

Forgone Care, Summer 2020 to Winter 2021

NOTES: Estimates are representative of beneficiaries who were continuously enrolled in Medicare from the beginning of 2020 and still alive, living in the community, and eligible and enrolled in Medicare at the time of 

their COVID-19 Summer, Fall, or Winter Supplement interview. Beneficiaries living in the community answered questions themselves or by proxy. In Summer, respondents were asked ヱAt any time since the beginning of 

the coronavirus outbreak, did you need medical care for something other than coronavirus, but not get it because of the coronavirus outbreak?ヮ In Fall, respondents were asked ヱSince July 1, 2020, did you need 

medical care for something other than coronavirus, but not get it because of the coronavirus pandemic?ヮ In Winter, respondents were asked ヱSince November 1, 2020, did you need medical care for something other 

than coronavirus, but not get it because of the coronavirus pandemic?ヮ Weights used for these estimates are preliminary weights and these estimates should therefore be interpreted with caution. 

Proportion of Beneficiaries Living in the Community 

Reporting Forgone Care Due to COVID-19

SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey COVID-19 Summer 2020, Fall 2020, and Winter 2021 PUFs

20.9%

7.8% 6.6%

Summer 2020 Fall 2020 Winter 2021

-13.1%

For details about analytic steps, 

view the MCBS Advanced Tutorial 

on the COVID-19 Supplement Data: 

https://www.cms.gov/ResearchStatistics-Data-andSystems/Research/MCBS/DataBriefs
MCBS COVID-19 COMMUNITY SUPPLEMENT : RESULTS – WINTER 2021 SUPPLEMENT 17

Among beneficiaries who reported forgone care since November 2020...

NOTES: Estimates are representative of beneficiaries who were continuously enrolled in Medicare from the beginning of 2020 and still alive, living in the community, and eligible and enrolled in Medicare at the time of 

their COVID-19 Winter Supplement interview. Weights used for these estimates are preliminary weights and these estimates should therefore be interpreted with caution. 

SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Preliminary Data from the Survey File, 2020.

1 Respondents were able to select more than one type

9%

15%

22%

29%

29%

32%

32%

The type of forgone health care varied1

(% of beneficiaries)

9%

14%

32%

45%

Beneficiaries decided to forgo care for 

various reasons 

(% of reasons)

13%

15%

24%

24%

24%

Health care providers rescheduled 

appointments for various reasons

(% of reasons)

Forgone Care, Winter 2021
MCBS COVID-19 COMMUNITY SUPPLEMENT : RESULTS – SUMMER 2020 TO WINTER 2021 SUPPLEMENTS 18

Sources of COVID-19 Information, Summer 2020 to Winter 2021

SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey COVID-19 Summer 

2020, Fall 2020, and Winter 2021 PUFs

More Medicare Beneficiaries 

relied on health care 

providers for information 

about COVID-19. Fewer 

relied on the Internet as the 

pandemic evolved.

Summer 2020 Fall 2020 Winter 2021
MCBS COVID-19 COMMUNITY SUPPLEMENT : RESULTS – WINTER 2021 SUPPLEMENT 19

COVID-19 Vaccine Uptake, Winter 2021

SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Preliminary Data from the Survey File, 2020.

NOTES: Estimates are representative of beneficiaries who were continuously enrolled in Medicare from the beginning of 2020 and still alive, living in the community, and eligible and enrolled in Medicare at the time of 

their COVID-19 Winter 2021 Supplement interview. Weights used for these estimates are preliminary weights and these estimates should therefore be interpreted with caution. 

1 Totals may not sum to 100 percent due to rounding and/or missingness

2 The percentage of beneficiaries who received their first dose in April 2021 has been suppressed

3 Eligible for Medicare due to disability

36%

64%

64% of beneficiaries reported receiving at 

least one dose of a COVID-19 vaccine during 

their interview

(% of beneficiaries)1

70% of older beneficiaries have

received at least one vaccine dose 

compared to 24% of beneficiaries 

under 653

67% of white beneficiaries have

received at least one vaccine dose 

compared to 53% of non-white 

beneficiaries4

0 doses At least 1 

dose

21%

50%

27%

1%

March 2021

February 2021

January 2021

December 2020

Month of first dose

(% of beneficiaries who received 

at least one dose)1,2

Since December 2020...
MCBS COVID-19 COMMUNITY SUPPLEMENT : RESULTS – WINTER 2021 SUPPLEMENT 20

Presumptive COVID-19 Vaccine Uptake, Winter 2021

Among beneficiaries who have not received any doses of a COVID-19 vaccine...

15%

9%

17%

14%

Definitely 45%

Probably

Not sure

Probably not

Definitely not

Over half of beneficiaries would 

definitely or probably get a 

COVID-19 vaccine

(% of beneficiaries)1

Among beneficiaries who would definitely or

probably get a vaccine...

The two most common reasons reported for not 

having received a vaccine during their interview 

were lack of availability (64%) and not 

belonging to a priority group (13%)

Among beneficiaries who would probably not or 

definitely not get a vaccine...

The two most common reasons reported for not 

having received a vaccine during their interview 

were concerns about vaccine safety or potential 

side effects (44%) and distrust of what the 

government says about the vaccine (29%)

SOURCE: Centers for Medicare & Medicaid Services, Medicare Current Beneficiary Survey, Preliminary Data from the Survey File, 2020.

NOTES: Estimates are representative of beneficiaries who were continuously enrolled in Medicare from the beginning of 2020 and still alive, living in the community, and eligible and enrolled in Medicare at the time of 

their COVID-19 Winter 2021 Supplement interview. Weights used for these estimates are preliminary weights and these estimates should therefore be interpreted with caution. 

1 Totals may not sum to 100 percent due to rounding and/or missingness
MCBS COVID-19 COMMUNITY SUPPLEMENT : CONCLUSIONS 21

Early and ongoing collaboration across federal agencies ensured 

rapid implementation of standardized COVID-19 items on the MCBS 

COVID-19 Community Supplements.

Limitation:

• Despite fielding similar items across the MCBS COVID-19 Community Supplements 

and the NCHS RANDS and NHIS surveys, benchmarking estimates is challenging 

due to differences in the surveys’ respective designs.

Future research:

• CMS continues to review opportunities for potential realignment with COVID-19 

items from other surveys.

• Are there ways to improve rapid cross-agency collaboration during a crisis so that 

consistent measures are used across surveys? 
Questions?

Other Resources: 

MCBS COVID-19 Advanced Tutorial:

• https://www.cms.gov/Research-Statistics-Data-andSystems/Research/MCBS/Data-Briefs

MCBS COVID-19 Data Tool:

• https://mcbs-interactives.norc.org/
Thank you!

Andrea Mayfield

Senior Research Director I

Mayfield-Andrea@norc.org

Kylie Carpenter

Principal Data Analyst

Carpenter-Kylie@norc.org

Rachel Carnahan

Research Director II

Carnahan-Rachel@norc.org

Elise Comperchio

Research Scientist

Comperchio-Elise@norc.org

Felicia LeClere

Senior Fellow

LeClere-Felicia@norc.org