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.

医疗补助计划是一个联合联邦和州的健康保险计划，今天覆盖7250万低收入家庭。 在《平价医疗法案》出台之前，医疗补助计划主要是针对美国的个人和残疾人。 涵盖低收入儿童、孕妇和残疾人。2010年平价医疗法 将医疗补助资格扩大到收入达到联邦贫困线138%的低收入成年人（16,753美元）; 一个人，2018年四口之家34，638美元）。数百万居住在低收入社区的家庭 在医疗补助扩大计划下获得了医疗保险，该计划已被32个州采用。许多 影响归因于医疗补助的扩大，包括对几个风险因素的积极影响， 直接有助于儿童和家庭的福祉，包括父母和儿童的心理健康问题， 药物滥用和家庭经济不稳定。家长抑郁，家长和青少年滥用药物， 家庭经济压力是虐待和忽视儿童、青少年暴力和亲密关系的重要风险因素。 伴侣暴力因此，有必要对医疗补助扩张的暴力预防效果进行调查 而且及时我们建议对预防虐待儿童的医疗补助扩展政策进行首次评估， 忽视、青年暴力和亲密伴侣暴力。本研究的目的包括评估 医疗补助计划扩大对报告和证实的虐待和忽视儿童案件（目标1），对青年暴力 犯罪报告、指控和判决（目标2），以及亲密伴侣暴力行为（目标3）。我们 这项研究利用了提供虐待儿童信息的国家数据库， 忽视报告和证据，以及关于亲密伴侣暴力行为的报告， 几个国家机构获得非公开的少年司法记录。我们12年的研究期是1月1日， 2008-2019年12月31日。这段时间确保我们可以跟踪研究结果（例如，虐待儿童比率 在医疗补助扩大（2014年生效）之前的六年和之后的六年里， 扩张.我们将比较选择扩大医疗补助的州内和选择扩大医疗补助的州之间的结果。 没有/没有选择扩大医疗补助。我们假设暴力会随着政策的实施而减少 在扩大医疗补助的州以及相对于没有扩大医疗补助的州实施。在 在拟议的研究中，我们将使用一种名为“CITS”的分析方法来进行这些比较。研究 研究结果将促进人们对如何预防低收入社区暴力的了解， 具体而言，为公众、决策者和其他利益相关者提供有关 医疗补助扩大对暴力初级预防的补充作用。结果将是 这与18个没有扩大医疗补助的州的政策制定者特别相关，其中许多人正在积极地 考虑采取这一政策。