States that expanded their Medicaid programs under the Affordable Care Act saw larger reductions in cases of child neglect compared with states that did not, according to an ecological study published in JAMA Network Open.
Emily C. B. Brown, MD, MS, from Seattle Children’s Research Institute and the University of Washington School of Medicine, and colleagues wrote that although many programs have been developed with the aim of reducing child maltreatment — “a broad term encompassing physical, sexual, and emotional abuse and neglect”— few have been consistently effective at reducing it. It has been theorized, the researchers wrote, that policies and programs that concentrate on reducing risk factors for maltreatment, including poverty and limited access to parental mental health care, could indirectly prevent maltreatment of children.
The expansion of Medicaid, which has been “associated with parents’ financial stability and access to mental health care,” is one such program, according to the researchers.
Brown and colleagues used data reported in the National Child Abuse and Neglect Data Systems between Jan. 1, 2010, and Dec. 31, 2016. They compared rates of physical abuse and neglect of children aged younger than 6 years between states that expanded Medicaid and those that did not.
During the study period, 31 states and the District of Columbia expanded their Medicaid programs, whereas 19 states did not. The baseline count of child neglect cases was 646,463 for states that expanded Medicaid and 388,265 for those that did not. After Medicaid expansion, 422 fewer cases of neglect per 100,000 children aged younger than 6 years (95% CI, –753 to –91) were reported each year.
Medicaid coverage increased 1.9% between 2013 and 2016 in the states that did not expand the program (interquartile range (IQR) = 0.4%-4.3%), whereas coverage increased 4.2% among states that did (IQR = 0.9%-6%).
However, the researchers said they found no associations between Medicaid coverage or Medicaid eligibility criteria and rates of physical abuse or neglect.
“This finding may suggest that the association between Medicaid expansion and neglect is complex and does not simply involve increased coverage,” Brown and colleagues wrote. “Another possibility is that a direct association exists between increased coverage and neglect but was not adequately detected in our analyses.” – by Katherine Bortz
Disclosures: Brown has provided expert testimony as part of her clinical responsibilities in cases of alleged child maltreatment and has reported receiving grants from Helfer Society during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.