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

医疗补助计划是一项联邦和州联合医疗保险计划，目前覆盖7250万低收入者 美国的个人和残疾人在《平价医疗法案》之前，医疗补助主要是 覆盖低收入儿童、孕妇和残疾人。2010年《平价医疗法案》 将医疗补助资格扩大到收入高达联邦贫困水平138%的低收入成年人(16,753美元 2018年，一个四口之家的个人收入为34,638美元)。数以百万计的家庭居住在低收入社区 在医疗补助扩大的情况下获得了医疗保险，这已经被32个州采用。许多 影响归因于医疗补助计划的扩大，包括对以下几个风险因素的积极影响 直接促进儿童和家庭福祉，包括父母和儿童的精神健康问题和 滥用药物和家庭经济不稳定。父母抑郁，父母和青少年滥用药物， 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主要风险因素 伴侣暴力。因此，有必要对扩大医疗补助的暴力预防效果进行调查 而且是及时的。我们建议对预防虐待儿童的医疗补助扩大政策进行首次评估，并 忽视、青少年暴力和亲密伴侣暴力。这项研究的目的包括评估 扩大关于报告和证实的虐待和忽视儿童案件的医疗补助(目标1)，关于青少年暴力 犯罪报告、指控和判决(目标2)，以及亲密伴侣实施暴力行为(目标3)。我们的 这项研究利用了可公开获得的国家数据库，这些数据库提供了有关虐待儿童和 忽视报告和事实，以及关于亲密伴侣暴力以及与 几个州的机构获取非公开的青少年司法记录。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，虐待儿童的比率 和忽视)，在医疗补助扩大(2014年生效)之前约六年，以及之后六年 扩张。我们将比较选择扩大医疗补助的州内以及选择扩大医疗补助的州之间的结果 是否选择扩大医疗补助。我们假设，在实施政策后，暴力事件将会减少 在扩大医疗补助的州以及与没有扩大医疗补助的州相关的州实施。在……里面 在建议的研究中，我们将使用一种名为“CITS”的分析方法来进行这些比较。学习 结果将促进对如何有效地防止低收入社区暴力的理解，以及更多 具体地说，向公众、政策制定者和其他利益相关者提供有关 扩大医疗补助在初级预防暴力方面的补充作用。结果将是 与18个没有扩大医疗补助计划的州的政策制定者尤其相关，其中许多州积极 正在考虑采用这一政策。

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.