A national evaluation of Medicaid expansion on the prevention of child abuse and neglect, youth violence, and intimate partner violence

对医疗补助扩大预防虐待和忽视儿童、青少年暴力和亲密伴侣暴力的国家评估

• 批准号: 9792359
• 负责人: Elizabeth J Letourneau
• 金额: $ 29.49万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9792359
• 关键词: national; evaluation; Medicaid; expansion; prevention

Medicaid is a joint federal and state health insurance program that today covers 72.5 million low-income individuals and people with disabilities in the U.S. Prior to the Affordable Care Act, Medicaid predominantly covered low-income children, pregnant women and individuals with disabilities. The 2010 Affordable Care Act expanded Medicaid eligibility to low-income adults earning up to 138% of the federal poverty level ($16,753 for a single individual, $34,638 for a family of four in 2018). Millions of families residing in low-income communities obtained health care coverage under Medicaid expansion, which has been adopted by 32 states. Many impacts have been attributed to Medicaid expansion, including positive impacts on several risk factors that directly contribute to child and family wellbeing, including parent and child mental health problems and substance misuse, and family financial instability. Parental depression, parent and youth substance misuse, and family financial stress are robust risk factors for child abuse and neglect, youth violence, and intimate partner violence. Thus, an investigation of the violence prevention effects of Medicaid expansion is warranted and timely. We propose the first evaluation of Medicaid expansion policy on the prevention of child abuse and neglect, youth violence, and intimate partner violence. The aims of this study include evaluating the impact of Medicaid expansion on reported and substantiated cases of child abuse and neglect (Aim 1), on youth violent crime reports, charges, and adjudications (Aim 2), and on intimate partner violence perpetration (Aim 3). Our study takes advantage of publically available national databases that provide information on child abuse and neglect reports and substantiations and on reports of intimate partner violence as well as relationships with several state agencies to obtain non-public juvenile justice records. Our 12-year study period is January 1, 2008-December 31, 2019. This period ensures that we can track study outcomes (e.g., rates of child abuse and neglect) for about six years prior to Medicaid expansion (which took effect in 2014) and six years after expansion. We will compare outcomes within states that chose to expand Medicaid and between states that did/did not choose to expand Medicaid. We hypothesize that violence will have declined following policy implementation in states that expanded Medicaid and also relative to states that did not expand Medicaid. In the proposed study, we will use an analytic approach called “CITS” to conduct these comparisons. Study results will advance understanding of what works to prevent violence in low-income communities and, more specifically, provide the public, policy makers, and other stakeholders with objective information regarding the complementary effects of Medicaid expansion on the primary prevention of violence. Results will be of particular relevance to policy makers in the 18 states that did not expand Medicaid, many of whom are actively considering adoption of this policy.

Medicaid是一项联合联邦和州健康保险计划，今天覆盖7250万个低收入 在《平价医疗法案》之前，美国的个人和残疾人主要是医疗补助 涵盖低收入儿童，孕妇和残疾人。 《 2010年平价医疗法案》 扩大的医疗补助资格对低收入成年人的资格最高可达联邦贫困水平的138％（$ 16,753 一个人，2018年四口之家为34,638美元）。居住在低收入社区的数百万家庭 在医疗补助扩张下获得了医疗保健覆盖范围，该保健已由32个州采用。许多 影响归因于医疗补助的扩张，包括对几种风险因素的积极影响 直接为儿童和家庭福祉做出贡献，包括父母和儿童心理健康问题以及 物质遗物和家庭金融不稳定。父母抑郁症，父母和青年物质遗物， 家庭经济压力是虐待和忽视儿童，青年暴力和亲密的强大风险因素 伴侣暴力。这是保证医疗补助扩张的暴力预防影响的投资 和及时。我们建议对医疗补助扩张政策进行首次评估，以预防虐待儿童和 忽视，青年暴力和亲密伴侣暴力。这项研究的目的包括评估 医疗补助扩大报告和证实的虐待和忽视案件（AIM 1），关于青年暴力行为 犯罪报告，指控和调整（AIM 2）以及亲密伴侣暴力实施暴力（AIM 3）。我们的 研究利用了公开可用的国家数据库，这些数据库提供有关虐待儿童和的信息 忽视报告和证实以及亲密伴侣暴力的报告以及与 几个州机构获得非公共少年司法记录。我们的12年学习期是1月1日 2008年12月31日，2019年。这一时期确保我们可以跟踪学习成果（例如，虐待儿童的比率 忽视）在医疗补助扩张之前大约六年（2014年生效）和六年后 扩张。我们将比较选择扩大医疗补助的州和在各州之间的结果 做过/没有选择扩大医疗补助。我们假设在政策之后的暴力行为将下降 在扩大医疗补助的州以及相对于没有扩大医疗补助的州的实施。在 拟议的研究，我们将使用称为“ CIT”的分析方法进行这些比较。学习 结果将促进了解哪些有效的防止低收入社区暴力行为的理解，以及更多 具体而言，为公众，政策制定者和其他利益相关者提供有关该的客观信息 医疗补助扩张对主要预防暴力的完全影响。结果将是 与未扩大医疗补助的18个州的政策制定者特别相关，其中许多是积极的 考虑采用该政策。