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America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.
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
Emerging Government Issues with Medicaid and Children's Health is an authoritative, insider's perspective on the strategic thinking behind reforming and improving the quality and access to health care for children across the United States. Featuring state health services officials and other children's health experts from across the country, this book provides a broad yet comprehensive overview of the role government officials and non-profits play in providing access to Medicaid benefits, as well as the obstacles faced by health care professionals in providing medical care to children and receiving insurance reimbursement for services provided. These leaders articulate the key points in the process of establishing Medicaid coverage for a child, from determining eligibility to detecting potential fraud, and discuss the strengths and weaknesses of the program as well as the reforms that could revolutionize the system. Additionally, the authors offer their predictions on future reform and share their advice for improving the communication channels between hospitals. Medicaid personnel, families, and social services departments. The different niches represented and the breadth of perspectives presented enable readers to get inside some of the great minds in children's health today, as these experts reveal the secrets and challenges behind ensuring that all of the nation's children receive the health care they deserve. Book jacket.