Medical Expenditure Panel Survey - Household and Medical Provider Components
OMB 0935-0118
The purpose of this request is to integrate several items into MEPS including several new questions related to COVID-19 (Attachment A) including telehealth (telemedicine) questions (Attachment B) into the CAPI questionnaire and a new self-administered questionnaire (SAQ) entitled, “Social and Health Experiences,” (see Attachment C). The questions on COVID-19 capture information on any delay in care due to COVID-19. The questions will be administered through an RU level gate question with follow up questions asked at the person level as appropriate. Telehealth (telemedicine) will be administered as its own event type with questions and probes mirroring those used for in-person medical provider visits. The Social and Health Experiences SAQ will include questions in a dual mode (web and paper) self-administered questionnaire about social and behavioral determinants of health including questions about housing affordability and quality, neighborhood characteristics, food security, transportation needs, financial strain, smoking and physical activity, and experiences with discrimination, social support, general well-being, personal safety, and adverse circumstances in childhood. Data collection will be for eligible adults (aged 18 and over). AHRQ proposes a mixed-mode (web and paper) primarily to further protect respondent’s privacy due to the sensitive nature of some of the items. Web completion will be the main mode with paper offered to those with barriers to internet access. In addition, due to COVID-19, in March of 2020, MEPS moved to telephone interviewing for all panels and rounds currently in the field with increased use of the web to facilitate respondent reporting; for example the use of showcards. The current plan is resume at least some face-to-face interviewing during the fall rounds for Panels 23, 24, and 25. Moreover, Panels 23 and 24 are to be extended one year with the creation of Round 6 and 7 interviews in order to contribute to the data collected for data years 2020 and 2021. The data collected will offset any impact on response rates due to the pandemic or changes in primary mode for data collection.
The latest form for Medical Expenditure Panel Survey - Household and Medical Provider Components expires 2023-11-30 and can be found here.
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Form and Instruction |
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Supporting Statement A |
Supporting Statement B |
Form 1 MEPS-HC Core Interview
SS Part A - MEPS-HC MPC - Economic Burden SAQ - 2025 062724.docx
MEPS-HC Core Interview MEPS-HC Core Interview
Federal Enterprise Architecture: Health - Health Care Services
| Form Attachment 32 | Attachment 32 – Attachment 32 HC Calendar Section | Fillable Fileable | Form and instruction |
| Form Attachment 45 | Attachment 45 – HC Employment Wage (EW) Section | Fillable Fileable | Form and instruction |
| Form Attachment 71 | Attachment 71 HC Event Follow Up Section | Fillable Fileable | Form and instruction |
| Form Attachment 70 | Attachment 70 HC RU Information Screener | Fillable Fileable | Form and instruction |
| Form Attachment 69 | Attachment 69 HC Reenumeration Subsection B | Fillable Fileable | Form and instruction |
| Form Attachment 68 | Attachment 68 HC Reenumeration Subsection | Fillable Fileable | Form and instruction |
| Form Attachment 67 | Attachment 67 HC Provider Roster Section | Fillable Fileable | Form and instruction |
| Form Attachment 38 | Attachment 38 – HC Child Preventive Health Supplement Section | Fillable Fileable | Form and instruction |
| Form Attachment 66 | Attachment 66 HC Provider Probes Section | Fillable Fileable | Form and instruction |
| Form Attachment 65 | Attachment 65 HC Prescribed Medicines Section | Fillable Fileable | Form and instruction |
| Form Attachment 64 | Attachment 64 HC Priority Conditions Enumeration Section | Fillable Fileable | Form and instruction |
| Form Attachment 63 | Attachment 63 HC Respondent Forms Section | Fillable Fileable | Form and instruction |
| Form Attachment 62 | Attachment 62 HC Quality Supplement Section | Fillable Fileable | Form and instruction |
| Form Attachment 61 | Attachment 61 HC Outpatient Department Section | Fillable Fileable | Form and instruction |
| Form Attachment 31 | Attachment 31 – Attachment 31 HC Assets Section. | Fillable Fileable | Form and instruction |
| Form Attachment 30 | Attachment 30 – HC Condition Enumeration Section | Fillable Fileable | Form and instruction |
| Form Attachment 29 | Attachment 29 –HC Access to Care Section | Fillable Fileable | Form and instruction |
| Form Attachment 56 | Attachment 56 HC Old Public Related Insurance (PR) Section | Fillable Fileable | Form and instruction |
| Form Attachment 55 | Attachment 55 HC Old Employment Health Insurance (OE) Section | Fillable Fileable | Form and instruction |
| Form Attachment 54 | Attachment 54 HC Managed Care (MC) Section | Fillable Fileable | Form and instruction |
| Form Attachment 52 HC | Attachment 52 HC Private Health Insurance Detail (HP) Section | Fillable Fileable | Form and instruction |
| Form Attachment 53 | Attachment 53 HC Time Covered Detail (HQ) Section | Fillable Fileable | Form and instruction |
| Form Attachment 51 | Attachment 51 Health Insurance (HX) Section | Fillable Fileable | Form and instruction |
| Form Attachment 50 | Attachment 50 Home Health Section | Fillable Fileable | Form and instruction |
| Form Attachment 49 | Attachment 49 HC Help Text | Fillable Fileable | Form and instruction |
| Form Attachment 48 | Attachment 48 Health Status Section | Fillable Fileable | Form and instruction |
| Form Attachment 47 | Attachment 47 Event Roster Section | Fillable Fileable | Form and instruction |
| Form Attachment 46 | Attachment 46 – HC Emergency Room Section | Fillable Fileable | Form and instruction |
| Form Attachment 44 | Attachment 44 – HC Employment Driver (OE) Section | Fillable Fileable | Form and instruction |
| Form Attachment 60 | Attachment 60 HC Other Medical Expense Section | Fillable Fileable | Form and instruction |
| Form Attachment 59 | Attachment 59 HC Medical Provider Section | Fillable Fileable | Form and instruction |
| Form Attachment 58 | Attachment 58 HC Income Section | Fillable Fileable | Form and instruction |
| Form Attachment 57 | Attachment 57 HC Hospital Stay Section | Fillable Fileable | Form and instruction |
| Form Attachment 43 | Attachment 43 – HC Review of Employment Information (RJ) Section | Fillable Fileable | Form and instruction |
| Form Attachment 42 | Attachment 42 – HC Employment (EM) Section | Fillable Fileable | Form and instruction |
| Form Attachment 41 | Attachment 41 – HC Event Driver Section | Fillable Fileable | Form and instruction |
| Form Attachment 40 | Attachment 40 – HC Dental Care Section | Fillable Fileable | Form and instruction |
| Form Attachment 39 | Attachment 39 – HC Institutional Care Section | Fillable Fileable | Form and instruction |
| Form Attachment 37 | Attachment 37 HC Flat Fee Section | Fillable Fileable | Form and instruction |
| Form Attachment 36 | Attachment 36 HC Charge Payment Section | Fillable Fileable | Form and instruction |
| Form Attachment 35 | Attachment 35 HC Start_Restart | Fillable Fileable | Form and instruction |
| Form Attachment 34 | Attachment 34 HC Closing Section | Fillable Fileable | Form and instruction |
| Form Attachment 33 | Attachment 33 Additional healthcare Section | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.
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