Census Matters: How the Census Shapes Funding for Seniors
In FY 2023, billions of dollars went to census-guided programs serving seniors. A census miscount can influence where billions of dollars go.
(Illustration: Luna Velez / POGO)
Census Matters is a Project On Government Oversight (POGO) series that tracks the distribution of census-guided federal funding to individual states and that details how the decennial census influences the allocation of those funds across the United States.
In our initial Census Matters report, POGO tracked how 371 federal assistance programs geographically distributed funds to states in fiscal year 2023.1 Those funds provide significant resources to many communities. In this report, POGO examines how census accuracy impacts critical federal funding for seniors (people aged 65 and above) and the services needed to support a wide range of areas that shape their lives, including health, housing, economic development, and more.
Many people may not realize how influential the census is in determining how much federal money gets allocated to different geographic regions across the country. Census-guided programs serving seniors deliver funds directly to communities, through an intermediary, or to state agencies. For example, Supportive Housing for the Elderly provides funds to intermediaries like private and nonprofit organizations that focus on providing affordable housing services.2 Depending on the program, it may use census data such as location, population, household income, and age to determine state eligibility and distribution.
The deficit or surplus of federal funding a state may receive stemming from inaccurate counts can directly impact the economic outcomes and quality of life for seniors. An undercount could mean fewer dollars, thereby fewer resources. An overcount could result in a state receiving more federal funds than its population warrants; for programs with fixed appropriations, this may proportionately reduce the share available to other states.
The Aging Population in the U.S. Continues to Grow
The Census Bureau found that the share of the U.S. population aged 65 or older has been increasing. This trend forecasts a growing demand for federal resources to assist an aging population.3 The growth of the U.S. population aged 65 and older is outpacing the population of children, and it is projected that more than 20% of the U.S. population will be over 65 by 2030.4 The different programs that seniors benefit from provide critical resources that help sustain basic needs such as health care, housing, workforce reentry, community development, and more. To ensure that their population is not missing out on resources they’re entitled to, it is important to get an accurate census count. However, seniors face unique challenges when it comes to the census. The following section describes potential barriers to counting individuals in this particular age group.
Persistent gaps in digital literacy
The 2020 Census was the first census that offered an online response option, in addition to the traditional paper form and phone response method. However, this shift disadvantaged older adults compared to other groups: Leading up to the decennial census in 2020, a Census Bureau survey found that 56% of seniors were uncomfortable completing the census online.5 This isn’t simply an access problem, although access remains a real barrier in rural communities. Even where internet access exists, digital literacy is another barrier for seniors.
Compared to other groups, seniors are less likely to self-respond online and more likely to rely on traditional methods, such as paper forms, telephone calls, or in-person enumerator visits.6 These methods take longer and require more follow-up, and each additional step in the process is a point where a senior could go uncounted (whether from a missed knock, an unreturned paper form, or fatigue with the process).
Complex housing arrangements
In 2021, Census Bureau officials noted that the 2020 census had been disrupted by a number of factors, such as facility closures caused by the COVID-19 pandemic, that made it hard to reach residents and adversely impacted the ability to collect quality data about individuals living in group housing. Considering that seniors may reside in group living quarters — such as nursing facilities and independent living communities — they face a greater risk of being miscounted.
These challenges have real fiscal consequences because many federal programs serving older people rely on census-derived population data to determine how funding is distributed across states and communities. And as the nation’s population continues to age, ensuring an accurate census count is becoming increasingly important in order to make sure federal resources keep pace with the growing demand for the services older people rely on.
Spending Distribution of Census-Guided Senior Programs
Of the 371 census-guided federal assistance programs operating in fiscal year 2023 that POGO identified, 28 were census-guided programs that served seniors. These programs accounted for approximately $1.57 trillion disbursed to all 50 states and Washington, DC, representing 70.30% of the total census-guided funding in FY 2023.
Of the 28 programs, Medicaid and its Part D Clawback (a separate program where, instead of covering medical costs, it is a monthly required payment states must make to the federal government to cover prescription drug costs) and Medicare Part A and B (Part A covers hospital and inpatient care services, Part B covers outpatient and physician services) consistently remain the largest programs. Medicaid with $610.15 billion, Medicaid Part D Clawback with $15.51 billion, and Medicare Part A and B with $906 billion combined. The next largest programs after Medicaid and Medicare are Social Services Block Grant with $1.59 billion, Special Programs for the Aging, Title III, Part C, Nutrition Services with $805.32 million, Special Programs for the Aging, Title III, Part B, Grants for Supportive Services and Senior Centers with $469.36 million, and National Family Caregiver Support, Title III, Part E with $188.14 million. These programs span different categories of spending, affecting an individual’s access to basic human resources such as health and housing.
How Missed Dollars Can Affect the Senior Population
As the U.S. population grows older, there may be more demand for services and resources that federal programs offer. Therefore, an accurate census count is critical to ensure that the government allocates federal funds where they are needed. POGO found 28 census-guided programs that the federal government funds to provide services that support the senior population. The following examples illustrate how the services of federal assistance programs address their different needs.
Health
In FY 2023, we tracked 14 census-guided health programs serving seniors.
Medicaid and Medicare are some of the largest federal assistance programs that provide seniors with health care. Both programs use the Federal Medical Assistance Percentage (FMAP), which is formulated based on population data derived from the census.7 If there is a population miscount, it can directly influence the amount of funding a state receives.
Relatedly, one census-guided program provides seniors with the technical assistance and outreach resources they need to navigate enrollment in critical safety-net programs like Medicare and Medicaid.8 Without support from programs like the Medicare Enrollment Assistance Program, eligible seniors, particularly those who are low-income, isolated, or less comfortable with technology, risk missing out on benefits they’re entitled to.
Alongside Medicare and Medicaid, there are programs that provide a wide range of services such as nutrition and rehabilitation services, prevention of elder abuse, ombuds services, and other supportive services.9 Some of these programs allocate funding based on each state’s share of the population aged 60 and over, not just seniors 65 and over.10
Housing
In FY 2023, we tracked nine census-guided housing programs serving seniors.
Second to health programs, seniors are major beneficiaries of housing programs such as Section 8 Housing Choice Vouchers, Public and Indian Housing, and Mortgage Insurance Rental and Cooperative Housing for Moderate Income Families and Elderly, Market Interest Rate.11 In FY 2023, the aforementioned housing programs received a national amount of $29.71 billion, $4.83 billion, and $4.04 billion, respectively.
Housing programs may use census data such as population size, age, and income data to determine allocation, with age-specific data playing a particularly important role in senior housing programs. A miscount could influence one or more of these data points, thereby influencing how much housing support is provided to a specific area or state.
Individuals with Disabilities
In FY 2023, we tracked 15 census-guided programs that serve seniors with disabilities.
As the population of people aged 65 and older increases in the U.S., disabilities become a more significant issue. Age-related conditions such as chronic illness and mobility limitations, as well as increased medical visits, mean seniors will likely face greater needs for assistance to deal with a range of disability issues. As a result, federal programs may play a greater role in supplying resources to these older individuals.
Based on our data, there is notable overlap between programs that serve seniors and individuals with disabilities. Fifteen out of 28 (53.6%) programs serving seniors also serve individuals with disabilities. Millions of recipients rely on such programs to meet basic needs, and the census influences billions of dollars across these programs.
Community Efforts in Anticipation of the Next Decennial Census
Census miscounts (depending on the severity) can result in states and communities losing significant federal funding across many programs. Communities, especially those that are historically underserved, could experience financial shortfalls and are most vulnerable to barriers that make it more challenging to maximize federal dollars.
Preparation for a decennial census can begin before the previous census has even been conducted. For instance, the early planning phase for the 2030 census began in 2019. Currently, we are in the second half of census preparation, specifically the Development and Integration Phase, where the Census Bureau continues doing research, collects data from two different test sites, and refines its operational design.12 During this phase, advocates can take part in a public education campaign to promote participation and psychological safety, can form Complete Count Commissions to raise general awareness and encourage residents to respond to the census, and can increase state collaboration with and participation in census partnership programs. Also, states can invest in efforts to avoid a significant miscount by partnering with city leaders, or accounting for census efforts in the state budget.13
Tribal, local, and state governments may also prepare for and participate in census partnership programs like the Local Update of Census Addresses (LUCA) operations. LUCA is an opportunity for tribal, local, and state governments to review and update the Census Bureau’s address list for their geographic area prior to the 2030 census, which may improve the completeness and accuracy of the count. They can verify the accuracy of address lists and make any corrections or identify any missing information, including address additions, deletions, conversions, and spatial updates. LUCA stands out as one of the few opportunities for tribal, local, and state governments to directly improve census accuracy in their jurisdictions on a standardized, nationwide timeline.14
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POGO used the following sources and methods to calculate the total FY 2023 spending for each senior program and state.
Federal Funds Information for States (FFIS)
The Federal Funds Information for States (FFIS) is an organization that tracks and analyzes more than 90% of federal funds flowing to state and local governments. The organization shared its FY 2023 spending data with POGO on the condition that program-specific spending amounts by state not be published. POGO sourced spending amounts for two programs from the FFIS data covering $15.9 billion, or about 1% of the funding tracked in this report.
Spending data for some federal assistance programs tracked by FFIS is split into sub-programs or activity areas. POGO combined these sub-program spending amounts into single spending totals in each state for each program.
USAspending.gov
The website USAspending.gov is the primary portal to access federal award data, including contracts, grants, direct payments, and loans. POGO sourced spending data for 14 programs from USAspending.gov covering $41.9 billion in spending, or about 2.7% of the funding tracked in this report.
For most programs, POGO used the place of performance for prime awards to calculate spending totals for each state; for five programs, recipient location was used instead of place of performance to identify the state location. These were programs for which the place of performance data did not include a specific state, likely because these programs awarded funds to intermediary entities such as banks or financial institutions that could potentially use the funds for activities beyond the state where they were located. POGO opted to use the state location of the recipients, as it was likely that is where most of these funds were used.
For programs that included loans and loan guarantees, POGO used the face value of those loans as the spending amount since it best represents that amount of assistance being provided.15
Assistance Listings
The Assistance Listings (previously the Catalog of Federal Domestic Assistance) is an annual government-wide compendium of federal programs, projects, services, and activities that provide assistance or benefits to the American public. POGO sourced FY 2023 spending totals for over $228.8 million in spending, or about 0.01% of the funding tracked in this report.
POGO estimated state-level spending data for these four programs based on the total FY 2023 spending reported for each program and on the observed rate of spending in each state for the 274 census-guided programs for which detailed state spending data was available, which includes many programs that are not focused on seniors. Both Medicare and Medicaid were excluded from the rate of spending calculation because the large spending amounts would significantly skew the average.
Agency Sources
Spending data posted by the agencies overseeing those programs were used to produce state specific allocation totals for many programs. These sources included agency-based award datasets, budget materials, program reports, and more. POGO sourced spending data for eight programs from agency sources covering $1.52 trillion in spending, or about 96.3% of the funding tracked in this report.
Medicaid
POGO sourced state-level spending data for Medicaid from “Exhibit 16: Medicaid Spending by State, Category, and Source of Funds, FY 2023 (millions)” from the Medicaid and CHIP Payment and Access Commission’s MACStats: Medicaid and CHIP Data Book.16
For any questions on data sources or methodology, please contact POGO at [email protected].
