title: Medicaid Disenrollment Patterns Among Children Coming into Contact with Child Welfare Agencies.
abstract: Objectives To examine retention of Medicaid coverage over time for children in the child welfare system. Methods We linked a national survey of children with histories of abuse and neglect to their Medicaid claims files from 36 states, and followed these children over a 4 year period. We estimated a Cox proportional hazards model on time to first disenrollment from Medicaid. Results Half of our sample (50 %) retained Medicaid coverage across 4 years of follow up. Most disenrollments occurred in year 4. Being 3-5 years of age and rural residence were associated with increased hazard of insurance loss. Fee-for-service Medicaid and other non-managed insurance arrangements were associated with a lower hazard of insurance loss. Conclusions for Practice A considerable number of children entering child environments seem to retain Medicaid coverage over multiple years. Finding ways to promote entry of child welfare-involved children into health insurance coverage will be critical to assure services for this highly vulnerable population.
authors.affiliation: School of Social Work, Rutgers, The State University of New Jersey, 536 George Street, New Brunswick, NJ, 08901, USA. ramesh.raghavan@rutgers.edu.
authors.forename: Ramesh
authors.identifier: 0000-0003-1478-7046
authors.initials: R
authors.lastname: Raghavan
authors.affiliation: RTI International, Research Triangle Park, NC, 27709, USA.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Allaire
authors.affiliation: Brown School, Washington University in St. Louis, Campus Box 1196, St. Louis, MO, 63130, USA.
authors.forename: Derek S
authors.initials: DS
authors.lastname: Brown
authors.affiliation: Brown School, Washington University in St. Louis, Campus Box 1196, St. Louis, MO, 63130, USA.
authors.forename: Raven E
authors.initials: RE
authors.lastname: Ross
mesh_terms: D002648:Child; D002649:Child Abuse; D002662:Child Health Services / Q000706:statistics & numerical data; D000068216:Child Protective Services; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008489:Medical Indigency / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012424:Rural Population; D014481:United States
keywords: Attrition; Child maltreatment; Medicaid; Retention