Study: Medicaid expansion linked to decrease in child neglect

The stability offered by Medicaid expansion may have contributed to a downtick in cases of child neglect, according to a study in JAMA Network Open. (jacoblund/Getty Images)

A decrease in reports of child neglect in states that participated in Medicaid expansion suggests the program plays a part in reducing child maltreatment, a new study found.

Child maltreatment costs the U.S. healthcare system upward of $428 billion per year in lifetime medical care and productivity losses, according to a 2015 study.

Medicaid expansion has been associated with improved financial stability for families and better access to mental health care, which led a research team at the University of Washington to look for a correlation between Medicaid expansion and improvement in rates of child abuse and neglect.

The team’s study, published in JAMA Network Open, found a link between Medicaid expansion and decreased numbers of child neglect cases.

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This type of complex interaction can make it difficult to identify or develop best practices for treating social determinants of health, which affect outcomes without manifesting in ways clinicians can easily diagnose or treat.

“The first step is to identify a policy or practice that could have a theoretical association with the outcome of interest—in our case, child maltreatment,” the study’s lead author, Emily C.B. Brown, M.D., of Seattle Children’s Research Institute and the University of Washington School of Medicine, told FierceHealthcare. 

After finding that association, researchers have to go back to the drawing board to understand why and how it works before they can develop policy recommendations for prevention. Researchers encounter a unique set of challenges at each step.

The study’s limitations meant it could not pinpoint the exact mechanism by which Medicaid expansion affects child neglect, which occurs when a caregiver fails to provide a child’s basic necessities or protection. The team’s study of actual child abuse, in which a caregiver physically harms a child, did not uncover a statistically significant association, suggesting the connection between child maltreatment and Medicaid programs may be complex.

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Studies like this one also demonstrate the need to cast a wide net for possible associations, especially for outcomes that have multiple dimensions and therefore are likely to have multiple causes—and multiple areas policymakers could attack.

Brown points out that her study adds to a growing body of work demonstrating an association between Medicaid expansion and child maltreatment.

“These studies all demonstrate that looking at possible associations is worthwhile, as they may help to prevent something complex, such as child maltreatment,” she says.