The effect of Affordable Care Act Medicaid expansions on foster care admissions

Beland, Louis‐Philippe; Huh, Jason; Kim, Dongwoo

doi:10.1002/hec.4419

Cited by 9 publications

(4 citation statements)

References 32 publications

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“…Nonetheless, with 2 exceptions, 36,37 medical records of child maltreatment cases have rarely been examined relative to economic and social policies. Prior research on the EITC, [3][4][5][6]28 minimum wage, 7,8 child tax credit, 5,28 low-income housing tax credit, 30 Supplemental Nutrition Assistance Program, 21,38 and Medicaid 39,40 has almost exclusively focused on child maltreatment reports, foster care admissions, or self-reported data.…”

Section: Limitationsmentioning

confidence: 99%

Association of Expanded Child Tax Credit Payments With Child Abuse and Neglect Emergency Department Visits

Bullinger

Boy

2023

JAMA Netw Open

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ImportancePoverty has long been associated with a higher risk for child maltreatment, and recent research suggests that income support policies are associated with reduced child abuse and neglect. However, income supports tied to employment cannot separate the associations of income from those of employment.ObjectiveTo estimate the short-term association of universal and unconditional income payments to parents with child abuse and neglect.Design, Setting, and ParticipantsIn this cross-sectional study, variation in the timing of the 2021 expanded child tax credit (CTC) advance payments was used to determine whether receiving unconditional income is associated with child abuse and neglect. A fixed-effects approach was used to compare child abuse and neglect before and after payments were made in 2021. The study compared 2021 trends with the same period in 2018 and 2019, during which no CTC payments were made. Participants were pediatric emergency department (ED) patients identified as experiencing child abuse or neglect at a level I pediatric hospital system in the Southeastern US from July through December 2021. Data were analyzed from July to August 2022.ExposuresTiming in the disbursement of the expanded CTC advance payments.Main Outcomes and MeasuresDaily child abuse and neglect-related ED visits.ResultsDuring the study period, there were 3169 ED visits related to child abuse or neglect. The 2021 advance payments of the expanded CTC were associated with fewer child abuse and neglect-related ED visits. There was a decrease in these ED visits in the 4 days following the advance CTC payments, although the reduction was not significant (point estimate, −0.22; 95% CI, −0.45 to 0.01; P = .06). There were significant reductions in such ED visits among male children (point estimate, −0.40; 95% CI, −0.75 to −0.06; P = .02) and non-Hispanic White children (point estimate, −0.69; 95% CI, −1.22 to −0.17; P = .01). These reductions did not persist, however.Conclusions and RelevanceThese findings suggest that federal income supports to parents are associated with immediate reductions in child abuse and neglect-related ED visits. These results are important for discussions of making the temporary expansion of the CTC permanent and are applicable to income support policies more broadly.

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Section: Limitationsmentioning

confidence: 99%

Association of Expanded Child Tax Credit Payments With Child Abuse and Neglect Emergency Department Visits

Bullinger

Boy

2023

JAMA Netw Open

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“…A growing literature examines the general effects of the ME and found positive effects on insurance coverage, health outcomes, and access and use of care services [7][8][9][10][11][12], admission to mental health treatment [13], reduction on mortality rates [14], foster care admissions [15], unpaid bills, and the amount of debt sent to third-party collection agencies [16]. Negative effects are also reported, for example, longer waiting times for appointments [17], cost-related barriers for senior citizens, delaying care, paying drug prescriptions, less access to specialist doctors, or lack of continuity of care for cost reasons [18].…”

Section: Introductionmentioning

confidence: 99%

The effects of Medicaid expansion on the racial/ethnic composition within nursing home residents

Loaiza

2024

Health Econ Rev

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Background The Affordable Care Act (ACA), enacted in 2010, aimed to improve healthcare coverage for American citizens. This study investigates the impact of Medicaid expansion (ME) under the ACA on the racial and ethnic composition of nursing home admissions in the U.S., focusing on whether ME has led to increased representation of racial/ethnic minorities in nursing homes. Methods A difference-in-differences estimation methodology was employed, using U.S. county-level aggregate data from 2000 to 2019. This approach accounted for multiple time periods and variations in treatment timing to analyze changes in the racial and ethnic composition of nursing home admissions post-ME. Additionally, two-way fixed effects (TWFE) regression was utilized to enhance robustness and validate the findings. Results The analysis revealed that the racial and ethnic composition of nursing home admissions has become more homogeneous following Medicaid expansion. Specifically, there was a decline in Black residents and an increase in White residents in nursing homes. Additionally, significant differences were found when categorizing states by income inequality, and poverty rate levels. These findings remain statistically significant even after controlling for additional variables, indicating that ME influences the racial makeup of nursing home admissions. Conclusions Medicaid expansion has not diversified nursing home demographics as hypothesized; instead, it has led to a more uniform racial composition, favoring White residents. This trend may be driven by nursing home preferences and financial incentives, which could favor residents with private insurance or higher personal funds. Mechanisms such as payment preferences and local cost variations likely contribute to these shifts, potentially disadvantaging Medicaid-reliant minority residents. These findings highlight the complex interplay between healthcare policy implementation and racial disparities in access to long-term care, suggesting a need for further research on the underlying mechanisms and implications for policy refinement.

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“…Thus, prevention requires policy intervention at the societal level. For example, policies addressing Medicaid expansion, paid family leave, earned income tax credit, and lack of waitlists to access subsidized childcare have each been associated with a decrease in child maltreatment …”

mentioning

confidence: 99%

Struggling to Stem the Tide of Child Maltreatment

Schilling,

Wood,

Christian

2024

JAMA

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The effect of Affordable Care Act Medicaid expansions on foster care admissions

Cited by 9 publications

References 32 publications

Association of Expanded Child Tax Credit Payments With Child Abuse and Neglect Emergency Department Visits

Association of Expanded Child Tax Credit Payments With Child Abuse and Neglect Emergency Department Visits

The effects of Medicaid expansion on the racial/ethnic composition within nursing home residents

Struggling to Stem the Tide of Child Maltreatment

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