Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion | Child Abuse | JAMA Network Open | JAMA Network
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1.
Felitti  VJ, Anda  RF, Nordenberg  D,  et al.  Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study.  Am J Prev Med. 1998;14(4):245-258. doi:10.1016/S0749-3797(98)00017-8PubMedGoogle ScholarCrossref
2.
Felitti  VJ.  Adverse childhood experiences and adult health.  Acad Pediatr. 2009;9(3):131-132. doi:10.1016/j.acap.2009.03.001PubMedGoogle ScholarCrossref
3.
Nemeroff  CB.  Paradise lost: the neurobiological and clinical consequences of child abuse and neglect.  Neuron. 2016;89(5):892-909. doi:10.1016/j.neuron.2016.01.019PubMedGoogle ScholarCrossref
4.
National Council of Juvenile and Family Court Judges. Adverse Childhood Experience (ACE) questionnaire. http://www.ncjfcj.org/sites/default/files/Finding%20Your%20ACE%20Score.pdf. Published October 24, 2006. Accessed December 5, 2016.
5.
US Department of Health and Human Services. Child abuse and neglect cost the United States $124 billion. http://www.cdc.gov/media/releases/2012/p0201_child_abuse.html. Published February 1, 2012. Accessed December 5, 2016.
6.
Fang  X, Brown  DS, Florence  CS, Mercy  JA.  The economic burden of child maltreatment in the United States and implications for prevention.  Child Abuse Negl. 2012;36(2):156-165. doi:10.1016/j.chiabu.2011.10.006PubMedGoogle ScholarCrossref
7.
Peterson  C, Florence  C, Klevens  J.  The economic burden of child maltreatment in the United States, 2015.  Child Abuse Negl. 2018;86:178-183. doi:10.1016/j.chiabu.2018.09.018PubMedGoogle ScholarCrossref
8.
US Department of Health and Human Services.  Child Maltreatment 2014. https://www.acf.hhs.gov/sites/default/files/cb/cm2014.pdf. Published January 25, 2016. Accessed May 9, 2019.
9.
Finkelhor  D, Turner  HA, Shattuck  A, Hamby  SL.  Prevalence of childhood exposure to violence, crime, and abuse: results from the National Survey of Children’s Exposure to Violence.  JAMA Pediatr. 2015;169(8):746-754. doi:10.1001/jamapediatrics.2015.0676PubMedGoogle ScholarCrossref
10.
Mikton  C, Butchart  A.  Child maltreatment prevention: a systematic review of reviews.  Bull World Health Organ. 2009;87(5):353-361. doi:10.2471/BLT.08.057075PubMedGoogle ScholarCrossref
11.
Scribano  PV.  Prevention strategies in child maltreatment.  Curr Opin Pediatr. 2010;22(5):616-620.PubMedGoogle Scholar
12.
Wood  JN.  Challenges in prevention of abusive head trauma.  JAMA Pediatr. 2015;169(12):1093-1094. doi:10.1001/jamapediatrics.2015.3023PubMedGoogle ScholarCrossref
13.
Curry  SJ, Krist  AH, Owens  DK,  et al; US Preventive Services Task Force.  Interventions to prevent child maltreatment: US Preventive Services Task Force recommendation statement.  JAMA. 2018;320(20):2122-2128. doi:10.1001/jama.2018.17772PubMedGoogle ScholarCrossref
14.
Klevens  J, Whitaker  DJ.  Primary prevention of child physical abuse and neglect: gaps and promising directions.  Child Maltreat. 2007;12(4):364-377. doi:10.1177/1077559507305995PubMedGoogle ScholarCrossref
15.
Klevens  J, Luo  F, Xu  L, Peterson  C, Latzman  NE.  Paid family leave’s effect on hospital admissions for pediatric abusive head trauma.  Inj Prev. 2016;22(6):442-445. doi:10.1136/injuryprev-2015-041702PubMedGoogle ScholarCrossref
16.
Klevens  J, Barnett  SB, Florence  C, Moore  D.  Exploring policies for the reduction of child physical abuse and neglect.  Child Abuse Negl. 2015;40:1-11. doi:10.1016/j.chiabu.2014.07.013PubMedGoogle ScholarCrossref
17.
The Henry J. Kaiser Family Foundation. Status of state action on the Medicaid expansion decision. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Published November 7, 2018. Accessed November 16, 2018.
18.
Ayanian  JZ, Ehrlich  GM, Grimes  DR, Levy  H.  Economic effects of Medicaid expansion in Michigan.  N Engl J Med. 2017;376(5):407-410. doi:10.1056/NEJMp1613981PubMedGoogle ScholarCrossref
19.
Anderson  ME, Glasheen  JJ, Anoff  D, Pierce  R, Lane  M, Jones  CD.  Impact of state Medicaid expansion status on length of stay and in-hospital mortality for general medicine patients at US academic medical centers.  J Hosp Med. 2016;11(12):847-852. doi:10.1002/jhm.2649PubMedGoogle ScholarCrossref
20.
Lyon  SM, Douglas  IS, Cooke  CR.  Medicaid expansion under the Affordable Care Act: implications for insurance-related disparities in pulmonary, critical care, and sleep.  Ann Am Thorac Soc. 2014;11(4):661-667. doi:10.1513/AnnalsATS.201402-072PSPubMedGoogle ScholarCrossref
21.
Rudowitz  R, Artiga  S, Young  K. What coverage and financing is at risk under a repeal of the ACA Medicaid expansion? http://kff.org/report-section/what-coverage-and-financing-is-at-risk-under-a-repeal-of-the-aca-medicaid-expansion-issue-brief/. Published December 6, 2016. Accessed March 15, 2017.
22.
Antonisse  L, Garfield  R, Rudowitz  R, Artiga  S. The effects of Medicaid expansion under the ACA: updated findings from a literature review. https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/. Published March 28, 2018. Accessed October 10, 2018.
23.
Bhatt  CB, Beck-Sagué  CM.  Medicaid expansion and infant mortality in the United States.  Am J Public Health. 2018;108(4):565-567. doi:10.2105/AJPH.2017.304218PubMedGoogle ScholarCrossref
24.
Wherry  LR, Miller  S.  Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions: a quasi-experimental study.  Ann Intern Med. 2016;164(12):795-803. doi:10.7326/M15-2234PubMedGoogle ScholarCrossref
25.
McMorrow  S, Gates  JA, Long  SK, Kenney  GM.  Medicaid expansion increased coverage, improved affordability, and reduced psychological distress for low-income parents.  Health Aff (Millwood). 2017;36(5):808-818. doi:10.1377/hlthaff.2016.1650PubMedGoogle ScholarCrossref
26.
Kenney  G, Anderson  N, Long  S,  et al.  Taking stock: health insurance coverage for parents under the ACA in 2014. http://hrms.urban.org/briefs/Health-Insurance-Coverage-for-Parents-under-the-ACA-in-2014.html. Published September 9, 2014. Accessed May 9, 2019.
27.
Jenny  C.  Child Abuse and Neglect: Diagnosis, Treatment, and Evidence. St Louis, MO: Saunders/Elsevier; 2011.
28.
US Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. National child abuse and neglect data system (NCANDS) child file, FFYs 2010-2016 [dataset]. http://www.ndacan.cornell.edu. Updated 2018. Accessed March 1, 2019.
29.
Kaiser Family Foundation. Medicaid income eligibility limits for parents, 2002-2018. https://www.kff.org/medicaid/state-indicator/medicaid-income-eligibility-limits-for-parents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Updated 2018. Accessed May 10, 2018.
30.
Centers for Disease Control and Prevention (CDC). Bridged-race population estimates. https://wonder.cdc.gov/bridged-race-population.html. Published June 30, 2016. Accessed March 29, 2017.
31.
Font  SA, Maguire-Jack  K.  Decision-making in child protective services: influences at multiple levels of the social ecology.  Child Abuse Negl. 2015;47:70-82. doi:10.1016/j.chiabu.2015.02.005PubMedGoogle ScholarCrossref
32.
Kohl  PL, Jonson-Reid  M, Drake  B.  Time to leave substantiation behind: findings from a national probability study.  Child Maltreat. 2009;14(1):17-26. doi:10.1177/1077559508326030PubMedGoogle ScholarCrossref
33.
Hussey  JM, Marshall  JM, English  DJ,  et al.  Defining maltreatment according to substantiation: distinction without a difference?  Child Abuse Negl. 2005;29(5):479-492. doi:10.1016/j.chiabu.2003.12.005PubMedGoogle ScholarCrossref
34.
Drake  B, Jonson-Reid  M, Way  I, Chung  S.  Substantiation and recidivism.  Child Maltreat. 2003;8(4):248-260. doi:10.1177/1077559503258930PubMedGoogle ScholarCrossref
35.
Leiter  J, Others  A.  Substantiated and unsubstantiated cases of child maltreatment: do their consequences differ?  Soc Work Res. 1994;18(2):67-82. doi:10.1093/swr/18.2.67Google ScholarCrossref
36.
Hammond  I, Eastman  AL, Leventhal  JM, Putnam-Hornstein  E.  Maternal mental health disorders and reports to child protective services: a birth cohort study.  Int J Environ Res Public Health. 2017;14(11):1320. doi:10.3390/ijerph14111320PubMedGoogle ScholarCrossref
37.
Parrish  JW, Shanahan  ME, Schnitzer  PG, Lanier  P, Daniels  JL, Marshall  SW.  Quantifying sources of bias in longitudinal data linkage studies of child abuse and neglect: measuring impact of outcome specification, linkage error, and partial cohort follow-up.  Inj Epidemiol. 2017;4(1):23. doi:10.1186/s40621-017-0119-6PubMedGoogle ScholarCrossref
38.
Putnam-Hornstein  E.  Report of maltreatment as a risk factor for injury death: a prospective birth cohort study.  Child Maltreat. 2011;16(3):163-174. doi:10.1177/1077559511411179PubMedGoogle ScholarCrossref
39.
Drake  B, Lee  SM, Jonson-Reid  M.  Race and child maltreatment reporting: are blacks overrepresented?  Child Youth Serv Rev. 2009;31(3):309-316. doi:10.1016/j.childyouth.2008.08.004PubMedGoogle ScholarCrossref
40.
Westat I, McDonald WR; US Administration for Children and Families Office of Planning, Research, and Evaluation. Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress. Washington, DC: US Dept of Health and Human Services, Administration for Children and Families, Office of Planning, Research and Evaluation and the Children's Bureau; 2010.
41.
Leclerc  B, Chiu  YN, Cale  J.  Sexual violence and abuse against children: a first review through the lens of environmental criminology.  Int J Offender Ther Comp Criminol. 2016;60(7):743-765. doi:10.1177/0306624X14564319PubMedGoogle ScholarCrossref
42.
Finkelhor  D, Shattuck  A, Turner  HA, Hamby  SL.  The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence.  J Adolesc Health. 2014;55(3):329-333. doi:10.1016/j.jadohealth.2013.12.026PubMedGoogle ScholarCrossref
43.
Hibbard  R, Barlow  J, Macmillan  H; Committee on Child Abuse and Neglect; American Academy of Child and Adolescent Psychiatry; Child Maltreatment and Violence Committee.  Psychological maltreatment.  Pediatrics. 2012;130(2):372-378. doi:10.1542/peds.2012-1552PubMedGoogle ScholarCrossref
44.
Kimber  M, MacMillan  HL.  Child psychological abuse.  Pediatr Rev. 2017;38(10):496-498. doi:10.1542/pir.2016-0224PubMedGoogle ScholarCrossref
45.
US Department of Health and Human Services.  Child maltreatment 2016. https://www.acf.hhs.gov/sites/default/files/cb/cm2016.pdf. Published 2018. Accessed May 9, 2019.
46.
Henry J. Kaiser Family Foundation. Health insurance coverage of adults with dependent children. http://kff.org/other/state-indicator/nonelderly-adults-with-dependents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Published 2017. Accessed March 15, 2017.
47.
US Census Bureau. Current Population Survey (CPS). https://www.census.gov/programs-surveys/cps.html. Accessed May 8, 2019.
48.
US Census Bureau. Current Population Survey (CPS): data. https://www.census.gov/programs-surveys/cps/data-detail.html. Revised March 6, 2018. Accessed May 8, 2019.
49.
National Partnership for Women & Families. State paid family and leave insurance laws. http://www.nationalpartnership.org/research-library/work-family/paid-leave/state-paid-family-leave-laws.pdf. Published February 2017. Accessed March 29, 2017.
50.
US Department of Labor, Bureau of Labor Statistics. Local area unemployment statistics. https://www.bls.gov/lau/. Updated 2017. Accessed March 29, 2017.
51.
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. National Vital Statistics System. https://www.cdc.gov/nchs/nvss/. Reviewed March 14, 2019. Accessed March 29, 2017.
52.
US Census Bureau. American Community Survey. https://www.census.gov/acs/www/data/data-tables-and-tools/index.php. Updated 2016. Accessed March 29, 2017.
53.
National Women’s Law Center. Persistent gaps: state child care assistance policies. https://nwlc.org/resources/persistent-gaps-state-child-care-assistance-policies-2017/. Updated 2017. Accessed September 9, 2017.
54.
Wing  C, Simon  K, Bello-Gomez  RA.  Designing difference in difference studies: best practices for public health policy research.  Annu Rev Public Health. 2018;39:453-469. doi:10.1146/annurev-publhealth-040617-013507PubMedGoogle ScholarCrossref
55.
SAS Institute. Influence statistics. SAS/STAT(R) 9.22 User's Guide https://support.sas.com/documentation/cdl/en/statug/63347/HTML/default/viewer.htm#statug_reg_sect040.htm. Accessed March 12, 2019.
56.
US Department of Health and Human Services.  Child Maltreatment 2015. https://www.acf.hhs.gov/sites/default/files/cb/cm2015.pdf. Published 2017. Accessed May 9, 2019.
57.
Rebbe  R.  What is neglect? state legal definitions in the United States.  Child Maltreat. 2018;23(3):303-315. doi:10.1177/1077559518767337PubMedGoogle ScholarCrossref
58.
Dubowitz  H, Christian  CW, Hymel  K, Kellogg  ND.  Forensic medical evaluations of child maltreatment: a proposed research agenda.  Child Abuse Negl. 2014;38(11):1734-1746. doi:10.1016/j.chiabu.2014.07.012PubMedGoogle ScholarCrossref
59.
Frean  M, Gruber  J, Sommers  BD.  Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.  J Health Econ. 2017;53:72-86. doi:10.1016/j.jhealeco.2017.02.004PubMedGoogle ScholarCrossref
60.
Medicaid.gov. State waivers list. https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html. Updated 2018. Accessed December 10, 2018.
61.
Henry J. Kaiser Family Foundation. Medicaid waiver tracker: approved and pending Section 1115 waivers by state. https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/. Published December 7, 2018. Accessed December 10, 2018.
62.
Snyder  L, Rudowitz  R. Medicaid financing: how does it work and what are the implications? https://www.kff.org/medicaid/issue-brief/medicaid-financing-how-does-it-work-and-what-are-the-implications/. Published May 20, 2015. Accessed January 22, 2019.
63.
Fallon  B, Trocmé  N, Fluke  J, MacLaurin  B, Tonmyr  L, Yuan  YY.  Methodological challenges in measuring child maltreatment.  Child Abuse Negl. 2010;34(1):70-79. doi:10.1016/j.chiabu.2009.08.008PubMedGoogle ScholarCrossref
64.
Sumner  SA, Mercy  JA, Dahlberg  LL, Hillis  SD, Klevens  J, Houry  D.  Violence in the United States: status, challenges, and opportunities.  JAMA. 2015;314(5):478-488. doi:10.1001/jama.2015.8371PubMedGoogle ScholarCrossref
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    Original Investigation
    Health Policy
    June 14, 2019

    Assessment of Rates of Child Maltreatment in States With Medicaid Expansion vs States Without Medicaid Expansion

    Author Affiliations
    • 1Seattle Children’s Research Institute, Center for Child Health, Behavior, and Development, Seattle, Washington
    • 2Department of Pediatrics, University of Washington School of Medicine, Seattle
    • 3Division of Child Psychiatry, University of Washington School of Medicine, Seattle
    • 4Department of Epidemiology, University of Washington School of Public Health, Seattle
    • 5Harborview Injury Prevention & Research Center, University of Washington, Seattle
    JAMA Netw Open. 2019;2(6):e195529. doi:10.1001/jamanetworkopen.2019.5529
    Key Points español 中文 (chinese)

    Question  Is the state expansion of Medicaid associated with rates of child physical abuse and neglect?

    Findings  In this ecological study comparing pre– and post–Medicaid expansion state-level rates of child physical abuse and neglect from the National Child Abuse and Neglect Data Systems, after adjusting for confounders, there were fewer cases of reported neglect (422 fewer per 100 000 younger than 6 years) in states that expanded Medicaid than during that time in nonexpansion states, which had a baseline rate of 3944 cases per 100 000 children younger than 6 years in 2013.

    Meaning  These results suggest that Medicaid expansion may serve as a means to prevent child neglect.

    Abstract

    Importance  Physical abuse and neglect affect a significant number of children in the United States. The 2014 Medicaid expansion, in which several states opted to expand their Medicaid programs, is associated with parental financial stability and access to mental health care.

    Objective  To determine whether Medicaid expansion is associated with changes in physical abuse and neglect rates.

    Design, Setting, and Participants  This ecological study used state-level National Child Abuse and Neglect Data Systems (NCANDS) data from January 1, 2010, through December 31, 2016, to compare the change in physical abuse and neglect rates in states that chose to expand Medicaid vs those that did not. All cases of physical abuse and neglect of children younger than 6 years during the study period that were referred to state-level Child Protective Services and screened in for further intervention after having met a maltreatment risk threshold were included. Cases with only documented sexual or emotional abuse were excluded. A difference-in-difference analysis was conducted from April 12, 2018, through March 26, 2019.

    Exposures  State-level Medicaid expansion status.

    Main Outcomes and Measures  Incidence rate of screened-in referrals for physical abuse or neglect per 100 000 children younger than 6 years per year by state.

    Results  Data were analyzed for 31 states and the District of Columbia that expanded Medicaid and 19 states that did not during the study period, with baseline neglect counts of 646 463 and 388 265, respectively. After Medicaid expansion, 422 fewer cases of neglect per 100 000 children younger than 6 years (95% CI, −753 to −91) were reported each year after adjusting for confounders for comparison of postexpansion and preexpansion rates in states that expanded Medicaid contrasting with the change during that time in nonexpansion states. From 2013 to 2016, Medicaid coverage for adults with dependent children increased a median 1.9% (interquartile range, 0.4% to 4.3%) in the states that did not expand Medicaid and 4.2% (interquartile range, 0.9% to 6.0%) in the states that did. No associations were found between Medicaid coverage or Medicaid eligibility criteria and physical abuse or neglect rates.

    Conclusions and Relevance  Medicaid expansion was associated with a reduction in the reported child neglect rate, but not the physical abuse rate. These findings suggest that expanding Medicaid may help prevent child neglect.

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