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Background Child maltreatment impacts a large number of children and has negative consequences through adulthood. Only a few programs and policies that aim to prevent child physical abuse and neglect have proven to be consistently effective. Policies and programs that address some of the risk factors for physical abuse and neglect (e.g., poverty, limited parental access to physical and mental health care) have been proposed as a means to prevent child maltreatment indirectly. The recent Patient Protection and Affordable Care Act (ACA) Medicaid expansion has been associated with improved adult financial stability and access to physical and mental health care. By impacting these parental factors, the Medicaid expansion may have also impacted child physical abuse and neglect outcomes. Since Medicaid expansion did not happen in all states or at the same time, this allowed for a comparison not just of maltreatment outcomes within states that expanded Medicaid before and after the expansion occurred, but also for a comparison of the same maltreatment outcomes between states that did expand Medicaid and those that did not as part of a “natural experiment.” Objective Determine whether the ACA Medicaid expansion was associated with a decreased rate of child physical abuse and neglect. Methods We conducted an observational study using data from the National Child Abuse and Neglect Data System (NCANDS) Child Files to evaluate rates of reported abuse and neglect for children under the age of 6 years over a 7-year period, from 2010 through 2016. We also used data available through the Henry J. Kaiser Family Foundation to evaluate state-level changes in Medicaid coverage proportions for parents as a possible intermediate step in the association between Medicaid expansion policies and child maltreatment outcomes. A difference-in-difference analysis was conducted in which the change in rates of physical abuse and neglect before and after expansion of Medicaid in states where Medicaid expansion occurred were compared to the change in rates seen in states that did not expand Medicaid on or after January 1st 2014 controlling for several state-level measures including unemployment and teenage birth rates. Results Medicaid coverage for adults with dependent children increased after 2014 by 2.3% in the states that did not expand Medicaid and by 3.7% in the states that did. The states that did not expand Medicaid saw a decrease in the Medicaid eligibility cutoff for parents of 11 percentage points of the FPL whereas the states that did expand saw the eligibility cutoff increase by 36.9 percentage points of the FPL. The proportion of parents covered by Medicaid was found to increase annually (p=0.01) and was positively associated with Medicaid expansion status (p=0.04). When comparing the years 2013 and 2016, Medicaid expansion was found to be associated with a significant increase in %FPL Medicaid eligibility (p
Background and Objectives: The number of US women using drugs during pregnancy has increased over the last decades, warranting concern as prenatal substance exposure (PSE) is associated with poor maternal and infant health outcomes. Policymakers have responded with child welfare laws targeting PSE, by designating behavioral and reproductive healthcare services as essential health benefits in the Affordable Care Act (ACA), and by expanding Medicaid eligibility thresholds. The goals of these policies are to curtail drug use during pregnancy, increase healthcare coverage, expand access to services, and improve outcomes. Minimal work has studied the impact of these policy changes on pregnant women seeking specialty substance use disorder (SUD) treatment, infant mortality, and maternal mortality. This dissertation seeks to understand the impact of ACA Medicaid expansion on (1) pregnant women seeking specialty substance use disorder treatment; and further evaluate how Medicaid expansion and prenatal substance exposure child abuse laws impact (2) infant, and (3) maternal mortality. Data and Design: Data were obtained for 2011-2017 from the Treatment Episode Data Set-Admissions (TEDS-A), for 2003-2017 from the National Center for Health Statistics (NCHS) natality and all-cause mortality files. We used difference-in-differences multivariable models to compare (1) differences in expansion and non-expansion states on wait time to treatment entry and rates of planned medication treatment for opioid use disorder (MOUD), (2) infant mortality and (3) maternal mortality in states with and without PSE child abuse laws in the context of ACA Medicaid expansion. Results: Medicaid expansion was associated with shorter wait times for treatment entry and increased planned use of MOUD. PSE child abuse laws were not associated with statistically significant changes in infant mortality when accounting for Medicaid expansion. States without PSE child abuse laws that adopted Medicaid expansion had a relative decrease in maternal mortality, however this change was not statistically significant. Conclusion: ACA Medicaid expansion is associated with improved access to care and better treatment for pregnant populations. PSE laws do appear to influence infant and maternal mortality, yet it is unclear whether that influence is meaningful in the context of ACA Medicaid expansion. Policy Implications: Medicaid expansion is associated with increased access to healthcare services, and PSE child abuse laws directly influence the strength of that effect. States governments are in a unique position to implement policies that can improve healthcare coverage and encourage at risk populations to interact with the healthcare system.
Past research on the effects of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) on suicide rates has focused on the “expansion population,” or adults up to 138 percent of the federal poverty line (FPL), but little is known about if the effects extend to children and young adults. This paper uses panel data from the U.S. Census Bureau’s American Community Survey (ACS) 1-year Estimates Tables for the years 2013 through 2018 and a U.S. Centers for Disease Control and Prevention (CDC) National Vital Statistics Report to try and produce an unbiased estimate of the relationship between a state’s Medicaid expansion status and suicide rates per 100,000 for children and young adults ages 10 to 24. Multivariate regression analyses using both time and entity fixed effects find mixed results in terms of a statistically significant relationship between expansion status and suicide rates among children and young adults. Although only one of the four regression models finds a statistically significant relationship, all four models in this analysis show evidence that an expanded Medicaid program is associated with lower suicide rates among children and young adults at varying levels of significance. The results of this study could help inform future research on the effect of Medicaid expansion on suicide rates for children and young adults that may uncover more definitive evidence of expansion’s negative association with suicide rates. Any such evidence would help build on the existing research surrounding Medicaid expansion under the ACA and help better understand the program’s viability as a policy lever for suicide prevention.
Child neglect is the most common type of child maltreatment. Substantial evidence indicates that the morbidity and mortality associated with neglect are significant, with enormous costs to the children involved and to society. Yet there is no major text focused exclusively on child neglect. Neglected Children presents a comprehensive and critical portrait of the phenomenon of neglect, based on theory, research and clinical practice experience. The editor and the contributing authors present a rich, interdisciplinary conceptualization with a broad view of neglect, moving far beyond the current child welfare focus on parental omissions in care. This broader view is essential to seriously addressing the complex and pervasive underpinnings of neglect.
This Handbook examines core questions still remaining in the field of child maltreatment. It addresses major challenges in child maltreatment work, starting with the question of what child abuse and neglect is exactly. It then goes on to examine why maltreatment occurs and what its consequences are. Next, it turns to prevention, treatment and intervention, as well as legal perspectives. The book studies the issue from the perspective of the broader international and cross-cultural human experience. Its aim is to review what is known, but even more importantly, to examine what remains to be known to make progress in helping abused children, their families, and their communities.
Health Insurance is a Family Matter is the third of a series of six reports on the problems of uninsurance in the United Sates and addresses the impact on the family of not having health insurance. The book demonstrates that having one or more uninsured members in a family can have adverse consequences for everyone in the household and that the financial, physical, and emotional well-being of all members of a family may be adversely affected if any family member lacks coverage. It concludes with the finding that uninsured children have worse access to and use fewer health care services than children with insurance, including important preventive services that can have beneficial long-term effects.
The decoupling of child Medicaid from the cash welfare system greatly increased access to public health insurance for low-income children in the United States. In this paper, I show that the federally mandated public health insurance expansions of the late-1980s and early-1990s significantly increased the number of public high school completers in the 2000s. Using the legislated generosity of a state's child Medicaid program as a time-varying, exogenous source of variation in a quasi-experimental design, I find substantively large declines in the dropout rate and, importantly, large increases in traditional 4-year graduation rates. Results for both measures are driven by Hispanic and White students, the two groups experiencing the greatest within-group increases in eligibility due to the decoupling of child Medicaid from the Aid to Families with Dependent Children program. In addition, I find evidence that increases in the length of childhood years covered (e.g., through age 5 vs. through age 17) leads to greater gains in completion rates. This suggests that public health insurance coverage throughout childhood produces the largest effect.