{
  "state": {
    "description": "USPS 2-letter state abbreviation (50 states + DC)",
    "unit": "text",
    "year": null,
    "source_name": "N/A (identifier)",
    "source_url": "",
    "caveat": "Identifier column, not a data value."
  },
  "state_name": {
    "description": "Full state name",
    "unit": "text",
    "year": null,
    "source_name": "N/A (identifier)",
    "source_url": "",
    "caveat": "Identifier column, not a data value."
  },
  "alz_prevalence_65plus_pct": {
    "description": "Estimated percentage of the population age 65+ living with Alzheimer's dementia",
    "unit": "percent",
    "year": 2020,
    "source_name": "Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5 (data from Dhana et al., state/county prevalence model)",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "Modeled estimate based on 2020 age/sex/race population distributions, not a direct case count or registry; published in the 2025 F&F report."
  },
  "alz_count_65plus": {
    "description": "Estimated number of people age 65+ living with Alzheimer's dementia",
    "unit": "count",
    "year": 2020,
    "source_name": "Alzheimer's Association 2025 Alzheimer's Disease Facts and Figures, Table 5",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "Report gives this in thousands (1 decimal); value here is that figure x1000, rounded to nearest integer. Same modeled-estimate caveat as alz_prevalence_65plus_pct."
  },
  "alz_deaths_total": {
    "description": "Number of deaths with Alzheimer's disease as the underlying cause of death, by state",
    "unit": "count",
    "year": 2022,
    "source_name": "Alzheimer's Association 2025 Facts and Figures, Table 6, citing National Center for Health Statistics death certificate data",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "2022 is the most recent year with state-level mortality data available as of the 2025 report. US total for this column is 120,122 (rate 36.0/100k)."
  },
  "alz_deaths_per_100k": {
    "description": "Unadjusted (not age-adjusted) annual Alzheimer's death rate per 100,000 population",
    "unit": "rate per 100k",
    "year": 2022,
    "source_name": "Alzheimer's Association 2025 Facts and Figures, Table 6 (NCHS)",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "Report explicitly presents UNADJUSTED rates (not age-adjusted) so that larger/older-population states aren't penalized in the comparison; do not treat as age-standardized."
  },
  "alz_prevalence_rank": {
    "description": "State rank by alz_prevalence_65plus_pct, 1 = highest prevalence percentage",
    "unit": "rank (1=highest)",
    "year": 2020,
    "source_name": "Derived by this project from Table 5 percentages (not published directly by Alzheimer's Association)",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "Computed rank, not a value published in the source report. Ties broken by original table order."
  },
  "pop_total": {
    "description": "Total resident population",
    "unit": "count",
    "year": 2024,
    "source_name": "U.S. Census Bureau, Population Estimates Program, Vintage 2024",
    "source_url": "https://www2.census.gov/programs-surveys/popest/tables/2020-2024/state/totals/NST-EST2024-POP.xlsx",
    "caveat": "July 1, 2024 estimate."
  },
  "pop_65plus": {
    "description": "Population age 65 and older",
    "unit": "count",
    "year": 2023,
    "source_name": "Derived: 2024 Census population estimate x 2023 ACS pct_65plus share",
    "source_url": "https://www2.census.gov/programs-surveys/popest/tables/2020-2024/state/totals/NST-EST2024-POP.xlsx",
    "caveat": "Not a single published Census count; combines 2024 population total with 2023 ACS age-share, so treat as an approximation, not an official Census 65+ count."
  },
  "pct_65plus": {
    "description": "Percent of population age 65+",
    "unit": "percent",
    "year": 2023,
    "source_name": "U.S. Census Bureau, ACS 2023 1-Year Estimates, Geographic Comparison Table GCT0103",
    "source_url": "https://www2.census.gov/programs-surveys/acs/data/2023/1_year_geographic_comparison_tables/",
    "caveat": ""
  },
  "pct_85plus": {
    "description": "Percent of population age 85+",
    "unit": "percent",
    "year": 2023,
    "source_name": "U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT0104",
    "source_url": "https://www2.census.gov/programs-surveys/acs/data/2023/1_year_geographic_comparison_tables/",
    "caveat": ""
  },
  "pct_female": {
    "description": "Percent of population female",
    "unit": "percent",
    "year": 2024,
    "source_name": "KFF State Health Facts, Distribution by Gender (based on ACS 1-Year Estimates)",
    "source_url": "https://www.kff.org/other/state-indicator/distribution-by-gender/",
    "caveat": "Used because Census's own ranking GCT series does not publish a female-share table directly."
  },
  "pct_race_black": {
    "description": "Percent of population Black or African American alone",
    "unit": "percent",
    "year": 2023,
    "source_name": "U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT0202",
    "source_url": "https://www2.census.gov/programs-surveys/acs/data/2023/1_year_geographic_comparison_tables/",
    "caveat": ""
  },
  "pct_race_hispanic": {
    "description": "Percent of population Hispanic or Latino (any race)",
    "unit": "percent",
    "year": 2024,
    "source_name": "KFF State Health Facts, Distribution by Race/Ethnicity (ACS 1-Year Estimates)",
    "source_url": "https://www.kff.org/other/state-indicator/distribution-by-raceethnicity/",
    "caveat": ""
  },
  "median_age": {
    "description": "Median age of population",
    "unit": "years",
    "year": 2023,
    "source_name": "U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT0101",
    "source_url": "https://www2.census.gov/programs-surveys/acs/data/2023/1_year_geographic_comparison_tables/",
    "caveat": ""
  },
  "pct_veterans": {
    "description": "Percent of civilian population 18+ who are veterans",
    "unit": "percent",
    "year": 2023,
    "source_name": "U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT2101",
    "source_url": "https://www2.census.gov/programs-surveys/acs/data/2023/1_year_geographic_comparison_tables/",
    "caveat": ""
  },
  "median_household_income": {
    "description": "Median household income",
    "unit": "usd",
    "year": 2023,
    "source_name": "U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT1901",
    "source_url": "https://www2.census.gov/programs-surveys/acs/data/2023/1_year_geographic_comparison_tables/",
    "caveat": "Inflation-adjusted to 2023 dollars per Census convention."
  },
  "pct_below_poverty": {
    "description": "Percent of population below the poverty line",
    "unit": "percent",
    "year": 2023,
    "source_name": "U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT1701",
    "source_url": "https://www2.census.gov/programs-surveys/acs/data/2023/1_year_geographic_comparison_tables/",
    "caveat": ""
  },
  "pct_bachelors_plus": {
    "description": "Percent of population 25+ with a bachelor's degree or higher",
    "unit": "percent",
    "year": 2023,
    "source_name": "U.S. Census Bureau, ACS 2023 1-Year Estimates, GCT1502",
    "source_url": "https://www2.census.gov/programs-surveys/acs/data/2023/1_year_geographic_comparison_tables/",
    "caveat": ""
  },
  "unemployment_rate": {
    "description": "Unemployment rate",
    "unit": "percent",
    "year": 2026,
    "source_name": "U.S. Bureau of Labor Statistics, Local Area Unemployment Statistics, ranked state table",
    "source_url": "https://www.bls.gov/web/laus/laumstrk.htm",
    "caveat": "August 2026 preliminary, seasonally adjusted figure -- a different (much more recent) vintage than the ACS-based columns; do not average years without accounting for this."
  },
  "gini": {
    "description": "Gini index of income inequality (0=perfect equality, 1=perfect inequality)",
    "unit": "index (0-1)",
    "year": 2019,
    "source_name": "Wikipedia 'List of U.S. states and territories by income inequality', citing Census ACS table B19083",
    "source_url": "https://en.wikipedia.org/wiki/List_of_U.S._states_and_territories_by_income_inequality",
    "caveat": "Oldest-vintage column in the panel (2019). A 2022/2023 Census B19083 pull requires an API key that was unavailable in this session; direct data.census.gov table B19083 should be re-pulled for a fresher value if precision matters."
  },
  "pct_diabetes": {
    "description": "Percent of adults with diagnosed diabetes",
    "unit": "percent",
    "year": 2024,
    "source_name": "KFF State Health Facts, Adults with Diagnosed Diabetes (CDC BRFSS)",
    "source_url": "https://www.kff.org/other/state-indicator/adults-with-diabetes/",
    "caveat": "Tennessee blank: TN did not submit sufficient 2024 BRFSS sample for KFF to report a value."
  },
  "pct_obesity": {
    "description": "Percent of adults with obesity (BMI 30+)",
    "unit": "percent",
    "year": 2024,
    "source_name": "KFF State Health Facts, Adult Obesity (CDC BRFSS)",
    "source_url": "https://www.kff.org/state-health-policy-data/state-indicator/adult-obesity-bysex/",
    "caveat": "Tennessee blank, same BRFSS reporting-threshold reason as pct_diabetes."
  },
  "pct_hypertension": {
    "description": "Percent of adults ever told by a doctor they have hypertension",
    "unit": "percent",
    "year": 2023,
    "source_name": "KFF State Health Facts, Adults Told They Have Hypertension (CDC BRFSS)",
    "source_url": "https://www.kff.org/state-health-policy-data/state-indicator/adults-who-have-ever-been-told-by-a-doctor-that-they-have-hypertension/",
    "caveat": "Kentucky and Pennsylvania blank: KFF states these two states did not meet minimum sample requirements for inclusion in the 2023 release."
  },
  "pct_smoking": {
    "description": "Percent of adults who currently smoke",
    "unit": "percent",
    "year": 2024,
    "source_name": "KFF State Health Facts, Adult Smoking Rate (CDC BRFSS)",
    "source_url": "https://www.kff.org/other/state-indicator/smoking-adults-by-sex/",
    "caveat": "Tennessee blank (insufficient 2024 BRFSS sample)."
  },
  "pct_physical_inactivity": {
    "description": "Percent of adults with no leisure-time physical activity (proxy: 100 minus % reporting any physical activity)",
    "unit": "percent",
    "year": 2024,
    "source_name": "Derived from KFF State Health Facts, Participation in Physical Activity (CDC BRFSS)",
    "source_url": "https://www.kff.org/state-health-policy-data/state-indicator/participation-in-physical-activity-by-sex/",
    "caveat": "Calculated as 100 minus KFF's 'any physical activity in past month' measure -- a close but not identical proxy for BRFSS's classic 'no leisure-time physical activity' question. Tennessee blank."
  },
  "pct_depression": {
    "description": "Percent of adults ever told they have a depressive disorder",
    "unit": "percent",
    "year": 2024,
    "source_name": "America's Health Rankings, Depression (CDC BRFSS)",
    "source_url": "https://www.americashealthrankings.org/explore/measures/Depression_a",
    "caveat": "Tennessee value is 2023 (27.3%) because the 2024 BRFSS row for TN was marked unavailable nationally; all other states are 2024."
  },
  "pct_hearing_loss": {
    "description": "Percent of adults with any hearing loss",
    "unit": "percent",
    "year": 2016,
    "source_name": "CDC/NCHS, Any Hearing Loss by State, National Health Interview Survey 2014-2016 (Blackwell & Norris)",
    "source_url": "https://www.cdc.gov/nchs/data/health_policy/hearing_loss_table_SEs.pdf",
    "caveat": "Oldest data-year in the risk-factor block (2014-2016 pooled); no newer full 51-state BRFSS hearing-loss table was locatable in this session."
  },
  "pct_binge_drinking": {
    "description": "Percent of adults who binge/excessively drink",
    "unit": "percent",
    "year": 2024,
    "source_name": "America's Health Rankings, Excessive Drinking (CDC BRFSS)",
    "source_url": "https://www.americashealthrankings.org/explore/measures/ExcessDrink",
    "caveat": "AHR's 'excessive drinking' combines binge drinking (4+/5+ drinks/occasion) OR heavy weekly drinking, not pure binge-only prevalence. Tennessee blank (data unavailable on source page)."
  },
  "pct_uninsured": {
    "description": "Percent of total population without health insurance",
    "unit": "percent",
    "year": 2024,
    "source_name": "KFF State Health Facts, Health Insurance Coverage of the Total Population (ACS-based)",
    "source_url": "https://www.kff.org/state-health-policy-data/state-indicator/total-population/",
    "caveat": "ACS-based rather than BRFSS-based, so Tennessee is populated here even though it is blank in several BRFSS-sourced columns."
  },
  "primary_care_physicians_per_100k": {
    "description": "Primary care providers per 100,000 population",
    "unit": "rate per 100k",
    "year": 2025,
    "source_name": "America's Health Rankings, Primary Care Providers (CMS National Plan and Provider Enumeration System)",
    "source_url": "https://www.americashealthrankings.org/explore/measures/PCP_NPPES",
    "caveat": "Includes nurse practitioners and physician assistants alongside physicians, so this is broader than a 'physicians only' count."
  },
  "neurologists_per_100k": {
    "description": "Neurologists per 100,000 population",
    "unit": "rate per 100k",
    "year": 2024,
    "source_name": "American Academy of Neurology, 2025 Member Demographics Report, Table 10b",
    "source_url": "https://www.aan.com/siteassets/home-page/conferences-and-community/member-engagement/learn-about-aan-committees/strategic-planning-committee/25-member-demographics-report.pdf",
    "caveat": "Based on AAN membership records, not a full practitioner census; likely a modest, roughly uniform undercount of true neurologist supply."
  },
  "hospital_beds_per_1000": {
    "description": "Staffed hospital beds per 1,000 total population",
    "unit": "rate per 1000",
    "year": 2024,
    "source_name": "KFF State Health Facts, Hospital Beds by Ownership Type (AHA Annual Survey)",
    "source_url": "https://www.kff.org/state-health-policy-data/state-indicator/beds-by-ownership/",
    "caveat": "Covers staffed community hospital beds (~85% of all US hospitals report to the AHA Annual Survey)."
  },
  "nursing_home_beds_per_1000": {
    "description": "Nursing home beds per 1,000 population age 65+",
    "unit": "rate per 1000 (65+ population)",
    "year": 2026,
    "source_name": "Becker's Hospital Review, States ranked by nursing home beds per capita (May 2026), using Census population + KFF CNF bed data",
    "source_url": "https://www.beckershospitalreview.com/post-acute/states-ranked-by-nursing-home-beds-per-capita/",
    "caveat": "IMPORTANT: denominator is population 65+, not total population -- NOT directly comparable to hospital_beds_per_1000, which is per 1,000 TOTAL population."
  },
  "pct_rural": {
    "description": "Percent of state population classified as rural",
    "unit": "percent",
    "year": 2023,
    "source_name": "America's Health Rankings, Rural Population (Census ACS 1-Year)",
    "source_url": "https://www.americashealthrankings.org/explore/measures/pct_rural_b",
    "caveat": "2023 ACS-based estimate, not the 2020 decennial Census urban/rural classification."
  },
  "pm25_avg_ugm3": {
    "description": "Average annual fine particulate matter (PM2.5) concentration",
    "unit": "ug/m3",
    "year": 2023,
    "source_name": "America's Health Rankings, Air Pollution (source: EPA), 2022-2024 average",
    "source_url": "https://www.americashealthrankings.org/explore/measures/air",
    "caveat": "Reported as a 2022-2024 multi-year average by the source; year recorded as the midpoint (2023)."
  },
  "pct_water_system_violations": {
    "description": "Percent of community water systems with health-based violations",
    "unit": "percent",
    "year": null,
    "source_name": "Not sourced",
    "source_url": "",
    "caveat": "Left blank for all 51 states. EPA ECHO Drinking Water Dashboard and SDWIS state summaries are interactive/JS-driven and did not expose a scrapeable per-state violation-rate table; only a national aggregate (~4% of public water systems) was found. Populating this column requires a manual SDWIS state-by-state data pull."
  },
  "unpaid_caregivers_count": {
    "description": "Number of unpaid family/other caregivers of people with Alzheimer's or other dementias",
    "unit": "count",
    "year": 2024,
    "source_name": "Alzheimer's Association 2025 Facts and Figures, Table 10",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "Report gives this in thousands; value here is that figure x1000. US total 11,926,000."
  },
  "unpaid_caregiver_hours_millions": {
    "description": "Hours of unpaid care provided by family/other caregivers",
    "unit": "count (millions of hours)",
    "year": 2024,
    "source_name": "Alzheimer's Association 2025 Facts and Figures, Table 10",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "US total 19,161 million hours (~19.2 billion)."
  },
  "unpaid_caregiver_value_usd": {
    "description": "Estimated economic value of unpaid caregiving",
    "unit": "usd",
    "year": 2024,
    "source_name": "Alzheimer's Association 2025 Facts and Figures, Table 10",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "Report gives this in millions of dollars; value here is that figure x1,000,000. Valued at a blend of state minimum wage and median home-health-aide hourly cost (a conservative estimate per the report's own methodology note). US total $413,454 million (~$413.5 billion)."
  },
  "medicaid_dementia_spend_total_usd": {
    "description": "Total projected state Medicaid spending on people with Alzheimer's or other dementias",
    "unit": "usd",
    "year": 2025,
    "source_name": "Alzheimer's Association 2025 Facts and Figures, Table 22 (Lewin Model estimate, in 2024 dollars)",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "Report gives this in millions of dollars; value here is that figure x1,000,000. This is a projection for 2025, expressed in 2024 dollars, produced by the Lewin Group's actuarial model, not raw CMS claims."
  },
  "medicaid_ltss_spend_per_capita": {
    "description": "Medicaid dementia spending per capita (total state population)",
    "unit": "usd per capita",
    "year": 2025,
    "source_name": "Derived by this project: medicaid_dementia_spend_total_usd / pop_total",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "Computed value, not published directly. Numerator is 2025-projected dementia-specific Medicaid spend (Table 22); denominator is 2024 total population (Census), so there is a 1-year vintage mismatch between numerator and denominator. Also note this is total dementia-related Medicaid spend, not specifically LTSS/long-term-services-and-supports spend, which was not separately available by state."
  },
  "alz_state_plan": {
    "description": "Whether the state has a published state Alzheimer's/dementia plan (1=yes, 0=no)",
    "unit": "count (binary 0/1)",
    "year": 2024,
    "source_name": "Alzheimer's Impact Movement, State Alzheimer's Disease Plans",
    "source_url": "https://portal.alzimpact.org/storage/resources/media-items/StateAlzheimersDiseasePlans.pdf",
    "caveat": "Source states that every state, DC, and Puerto Rico has published a plan since 2007; all 51 rows are therefore 1. Plan VINTAGE varies widely by state (some updated 2020-2024, some older) -- presence of a plan does not imply currency."
  },
  "dementia_care_workforce_requirement": {
    "description": "Whether the state has a dementia-specific training mandate for direct care workers/facility staff (1=yes, 0=no)",
    "unit": "count (binary 0/1)",
    "year": 2024,
    "source_name": "NCCDP state-by-state dementia training breakdown; DC Municipal Code; PMC11690893 (aggregate 43-state stat); Justice in Aging 50-state survey",
    "source_url": "https://www.nccdp.org/federal-and-state-requirements-for-dementia-training-a-state-by-state-breakdown-of-current-guidelines/",
    "caveat": "26 of 51 rows are BLANK, not 0: a secondary aggregate source (PMC11690893) states 43 states have SOME dementia training requirement, meaning several blank rows here likely should be 1, but the individual per-state confirming PDFs (at act.alz.org and justiceinaging.org) were not opened one-by-one to verify which. Treat the 25 rows marked 1 as confirmed; treat blanks as 'unconfirmed', not 'no'."
  },
  "geriatricians_count": {
    "description": "Number of board-certified geriatricians practicing in the state (bonus column, not in required spec)",
    "unit": "count",
    "year": 2021,
    "source_name": "Alzheimer's Association 2025 Facts and Figures, Table 14, citing American Geriatrics Society",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "2021 is the most recent year available in the source report; included as a bonus workforce-supply column alongside primary_care_physicians_per_100k and neurologists_per_100k."
  },
  "medicare_percapita_ffs_payment_usd": {
    "description": "Per capita traditional Medicare fee-for-service payments for all Medicare beneficiaries with Alzheimer's/dementia (bonus column, not in required spec)",
    "unit": "usd per capita",
    "year": 2022,
    "source_name": "Alzheimer's Association 2025 Facts and Figures, Table 19, citing CMS",
    "source_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12040760/",
    "caveat": "'All Medicare' column from Table 19 (blends Medicare-only and dual-eligible beneficiaries); bonus column included alongside medicaid_dementia_spend_total_usd to give a Medicare-side cost comparison, not part of the originally requested column list."
  },
  "cms_nh_certified_beds_total": {
    "description": "Total CMS-certified nursing home beds in the state",
    "unit": "count",
    "year": 2026,
    "source_name": "CMS Care Compare, Nursing Home Provider Info",
    "source_url": "https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/4pq5-n9py",
    "caveat": "Direct sum of the county-level cms_nh_certified_beds_total/n_facilities columns by state; cms_nh_beds_per_1000_pop is recomputed as beds_sum / panel_state.csv's own population total * 1000 (not a sum of the per-1000 county rates). Connecticut is blank here: zero CMS nursing-home rows exist for CT under any FIPS scheme (county or planning region), a genuine absence in the CMS source, not a join gap -- see the cms_nh_* entries in panel_county_meta.json and data/dataset_expansion.json 'KNOWN LIMITATION' entry."
  },
  "cms_nh_n_facilities": {
    "description": "Number of CMS-certified nursing home facilities in the state",
    "unit": "count",
    "year": 2026,
    "source_name": "CMS Care Compare, Nursing Home Provider Info",
    "source_url": "https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/4pq5-n9py",
    "caveat": "Direct sum of the county-level cms_nh_certified_beds_total/n_facilities columns by state; cms_nh_beds_per_1000_pop is recomputed as beds_sum / panel_state.csv's own population total * 1000 (not a sum of the per-1000 county rates). Connecticut is blank here: zero CMS nursing-home rows exist for CT under any FIPS scheme (county or planning region), a genuine absence in the CMS source, not a join gap -- see the cms_nh_* entries in panel_county_meta.json and data/dataset_expansion.json 'KNOWN LIMITATION' entry."
  },
  "cms_nh_beds_per_1000_pop": {
    "description": "CMS-certified nursing home beds per 1,000 population (beds divided by panel_state.csv's own population column)",
    "unit": "beds per 1,000 population",
    "year": 2026,
    "source_name": "CMS Care Compare, Nursing Home Provider Info",
    "source_url": "https://data.cms.gov/provider-data/api/1/metastore/schemas/dataset/items/4pq5-n9py",
    "caveat": "Direct sum of the county-level cms_nh_certified_beds_total/n_facilities columns by state; cms_nh_beds_per_1000_pop is recomputed as beds_sum / panel_state.csv's own population total * 1000 (not a sum of the per-1000 county rates). Connecticut is blank here: zero CMS nursing-home rows exist for CT under any FIPS scheme (county or planning region), a genuine absence in the CMS source, not a join gap -- see the cms_nh_* entries in panel_county_meta.json and data/dataset_expansion.json 'KNOWN LIMITATION' entry."
  },
  "cms_ma_total_medicare_beneficiaries": {
    "description": "Total Medicare beneficiaries (Original Medicare + Medicare Advantage), state total, June 2026",
    "unit": "count (beneficiaries)",
    "year": 2026,
    "source_name": "CMS Medicare Monthly Enrollment",
    "source_url": "https://data.cms.gov/sites/default/files/2026-09/4f178691-06d8-4a77-96ea-43fa911e28b5/Medicare%20Monthly%20Enrollment%20Data_June%202026.csv",
    "caveat": "CMS Medicare Monthly Enrollment, June 2026. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk (state prefix '09' is unambiguous under either the legacy-county or post-2022-planning-region scheme). 78 source rows nationally had a CMS-suppressed beneficiary cell and were excluded from these sums, so states with small-county suppression have a floor value, not a complete count."
  },
  "cms_ma_advantage_beneficiaries": {
    "description": "Medicare Advantage and other plan beneficiaries, state total, June 2026",
    "unit": "count (beneficiaries)",
    "year": 2026,
    "source_name": "CMS Medicare Monthly Enrollment",
    "source_url": "https://data.cms.gov/sites/default/files/2026-09/4f178691-06d8-4a77-96ea-43fa911e28b5/Medicare%20Monthly%20Enrollment%20Data_June%202026.csv",
    "caveat": "CMS Medicare Monthly Enrollment, June 2026. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk (state prefix '09' is unambiguous under either the legacy-county or post-2022-planning-region scheme). 78 source rows nationally had a CMS-suppressed beneficiary cell and were excluded from these sums, so states with small-county suppression have a floor value, not a complete count."
  },
  "medicare_advantage_penetration_pct": {
    "description": "Medicare Advantage enrollment as a percent of total Medicare beneficiaries, June 2026 (= advantage_beneficiaries / total_medicare_beneficiaries * 100, from CMS's own published counts)",
    "unit": "percent (0-100)",
    "year": 2026,
    "source_name": "CMS Medicare Monthly Enrollment",
    "source_url": "https://data.cms.gov/sites/default/files/2026-09/4f178691-06d8-4a77-96ea-43fa911e28b5/Medicare%20Monthly%20Enrollment%20Data_June%202026.csv",
    "caveat": "CMS Medicare Monthly Enrollment, June 2026. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk (state prefix '09' is unambiguous under either the legacy-county or post-2022-planning-region scheme). 78 source rows nationally had a CMS-suppressed beneficiary cell and were excluded from these sums, so states with small-county suppression have a floor value, not a complete count."
  },
  "naics62_health_socasst_estabs": {
    "description": "Number of health care and social assistance establishments (NAICS 62, broad sector), 2024 annual average",
    "unit": "count",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics62_health_socasst_emplvl_annual_avg": {
    "description": "Average annual employment level at health care and social assistance establishments (NAICS 62), 2024",
    "unit": "count",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics62_health_socasst_total_annual_wages": {
    "description": "Total annual wages paid by health care and social assistance establishments (NAICS 62), 2024, US dollars",
    "unit": "US dollars",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics62_health_socasst_avg_annual_pay_usd": {
    "description": "Average annual pay per employee, health care and social assistance establishments (NAICS 62), 2024, US dollars",
    "unit": "US dollars",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics62_any_ownership_cell_suppressed": {
    "description": "'Y' if at least one of the 4 ownership-sector cells (Federal/State/Local government, Private) summed into the NAICS 62 state total was BLS-suppressed for confidentiality; blank otherwise",
    "unit": "flag ('Y' or blank)",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics623_nursing_residential_care_estabs": {
    "description": "Number of nursing and residential care facility establishments (NAICS 623, a subsector of 62), 2024 annual average",
    "unit": "count",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics623_nursing_residential_care_emplvl_annual_avg": {
    "description": "Average annual employment level at nursing and residential care facilities (NAICS 623), 2024",
    "unit": "count",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics623_total_annual_wages": {
    "description": "Total annual wages paid by nursing and residential care facilities (NAICS 623), 2024, US dollars",
    "unit": "US dollars",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics623_avg_annual_pay_usd": {
    "description": "Average annual pay per employee, nursing and residential care facilities (NAICS 623), 2024, US dollars",
    "unit": "US dollars",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "naics623_any_ownership_cell_suppressed": {
    "description": "'Y' if at least one of the 4 ownership-sector cells summed into the NAICS 623 state total was BLS-suppressed for confidentiality; blank otherwise",
    "unit": "flag ('Y' or blank)",
    "year": 2024,
    "source_name": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment",
    "source_url": "https://data.bls.gov/cew/data/files/2024/csv/2024_annual_by_industry.zip",
    "caveat": "BLS Quarterly Census of Employment and Wages (QCEW), county health-sector employment, 2024 annual averages. Computed directly from the source file (not from the county-joined panel), grouped by the 2-digit state FIPS prefix of county_fips -- this recovers real Connecticut figures without needing a county-level crosswalk. Counties BLS itself suppresses are excluded from their state's sum, so states containing a suppressed county have a floor value, not a complete count."
  },
  "medicaid_total_managed_care_enrollees_2024": {
    "description": "Total Medicaid managed-care enrollees, any program type, 2024",
    "unit": "count",
    "year": "2024",
    "source_name": "CMS Medicaid Managed Care Enrollment Report, Table 6 (data.medicaid.gov)",
    "source_url": "https://download.medicaid.gov/data/managed-long-term-services-and-supports-mltss-enrollees2024-table6.csv",
    "caveat": "51/51 states+DC matched by full state name to panel_state.csv's 2-letter code. Alaska has no 2024 value in the source file itself (reported as '--', left blank here, not zero)."
  },
  "medicaid_comprehensive_mltss_enrollees_2024": {
    "description": "Medicaid enrollees in Comprehensive Managed Care programs that include LTSS, 2024",
    "unit": "count",
    "year": "2024",
    "source_name": "CMS Medicaid Managed Care Enrollment Report, Table 6 (data.medicaid.gov)",
    "source_url": "https://download.medicaid.gov/data/managed-long-term-services-and-supports-mltss-enrollees2024-table6.csv",
    "caveat": "Measures managed-LTSS enrollment (utilization/program design), not dollars spent or per-resident cost. A unified state-by-state Medicaid nursing-facility per-diem reimbursement-rate file does not exist in the open Medicaid.gov catalogue (checked, not fabricated) -- each state publishes its own rate schedule independently."
  },
  "medicaid_comprehensive_mltss_pct_2024": {
    "description": "medicaid_comprehensive_mltss_enrollees_2024 as a percent of medicaid_total_managed_care_enrollees_2024",
    "unit": "percent",
    "year": "2024",
    "source_name": "CMS Medicaid Managed Care Enrollment Report, Table 6 (data.medicaid.gov)",
    "source_url": "https://download.medicaid.gov/data/managed-long-term-services-and-supports-mltss-enrollees2024-table6.csv",
    "caveat": "As published by CMS, not recomputed here."
  },
  "medicaid_ltss_only_enrollees_2024": {
    "description": "Medicaid enrollees in Managed LTSS-Only programs (LTSS carved out from other managed care), 2024",
    "unit": "count",
    "year": "2024",
    "source_name": "CMS Medicaid Managed Care Enrollment Report, Table 6 (data.medicaid.gov)",
    "source_url": "https://download.medicaid.gov/data/managed-long-term-services-and-supports-mltss-enrollees2024-table6.csv",
    "caveat": "Many states report '--' (not applicable, no LTSS-only program) -- left blank, not zero."
  },
  "medicaid_ltss_only_pct_2024": {
    "description": "medicaid_ltss_only_enrollees_2024 as a percent of medicaid_total_managed_care_enrollees_2024",
    "unit": "percent",
    "year": "2024",
    "source_name": "CMS Medicaid Managed Care Enrollment Report, Table 6 (data.medicaid.gov)",
    "source_url": "https://download.medicaid.gov/data/managed-long-term-services-and-supports-mltss-enrollees2024-table6.csv",
    "caveat": "As published by CMS, not recomputed here."
  }
}