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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    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.


    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.