Introduction
The U.S. Affordable Care Act Medicaid expansion, which allowed states to expand Medicaid
coverage to low-income adults beginning in 2014, has reduced the risk factors for
child neglect and physical abuse, including parental financial insecurity, substance
use, and untreated mental illness. This study examines the associations between Medicaid
expansion and the rates of overall, first-time, and repeat reports of child neglect
and physical abuse incidents per 100,000 children aged 0–5, 6–12, and 13–17 years.
Methods
The 2008–2018 National Child Abuse and Neglect Data System was analyzed using an extension
of the difference-in-differences approach that accounts for staggered policy implementation
across time. Owing to evidence of nonparallel preperiod trends in the 6 states that
expanded Medicaid from 2015 to 2017, the main analyses included 20 states that newly
expanded Medicaid in 2014 and 18 states that did not expand Medicaid from 2008 to
2018. Analyses were conducted in 2020–2021.
Results
Medicaid expansion states were associated with reductions of 13.4% (95% CI= −24.2,
−9.6), 14.8% (95% CI= −26.4, −1.4), and 16.0% (−27.6, −2.6) in the average rate of
child neglect reports per 100,000 children aged 0–5, 6–12, and 13–17 years, per state-year,
relative to control states. Expansion was associated with a 17.3% (95% CI= −28.9,
−3.8) reduction in the rate of first-time neglect reports among children aged 0–5
years and with 16.6% (95% CI= −29.3, −1.6) and 18.7% (95% CI= −32.5, −2.1) reductions
in the rates of repeat neglect reports among children aged 6–12 and 13–17 years, respectively.
There were no statistically significant associations between Medicaid expansion and
the rates of physical abuse among children in any age group.
Conclusions
Insurance expansions for low-income adults may reduce child neglect.
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Article Info
Publication History
Published online: September 21, 2021
Identification
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