Poster #62 - The Causal Effect of 12-Month Postpartum Medicaid Extensions on Child Maltreatment and Infant Welfare

• In Event: Friday Poster Reception

Abstract

The American Rescue Plan Act of 2021 provided states the option to extend Medicaid coverage from 60 days to a full 12 months postpartum. While the primary intent of this policy was to improve maternal health, this paper investigates a critical, unintended spillover: child welfare. Specifically, this study evaluates whether the extension of maternal health insurance causally reduces incidents of child maltreatment (abuse and neglect) during the first year of life. Detecting this effect is highly significant, given that infants face the highest victimization rates of maltreatment of any age group. While previous literature has extensively evaluated the initial 2014 ACA Medicaid expansions, this paper is the first to isolate the two-generation impact of the 2021 postpartum extensions within a post-COVID-19 economic environment. There can be two primary mechanisms driving the relationship between maternal coverage and infant welfare. In one hand, continuous insurance reduces parental financial strain and ensures uninterrupted access to maternal mental health and substance use treatment. Therefore, the policy may mitigate the economic and psychological causes of child neglect. However, increased medical contact through continuous pediatric and postpartum visits may increase reporting by mandated healthcare reporters. This paper disentangles these competing effects by comparing total screened-in reports against substantiated cases and foster care placements. This study utilizes a staggered Difference-in-Differences (DiD) design, exploiting the variation in adoption dates across states between 2022 and 2025. Policy implementation timelines are sourced from the Kaiser Family Foundation (KFF) Medicaid tracker. Child welfare outcomes include maltreatment reports and substantiations for infants under age one, drawn from the National Child Abuse and Neglect Data System (NCANDS). To isolate the policy effect, the model incorporates state-level controls for birth rates and maternal labor market conditions using CDC WONDER and IPUMS CPS data. For technical rigor, the standard Triple Difference (DDD) equation using two way fixed effects is also adopted using a "control group" of older children (ages 5–10) in the same state. Since the postpartum extension specifically targets the mother's first year after birth, I expect to see a shock for infants but no shock for 10-year-olds. This study anticipates that states adopting the 12-month extension will experience a measurable decline in neglect-related infant maltreatment cases. By isolating the 'Prevention' versus 'Surveillance' effects, this research provides vital cost-benefit justifications for continuous maternal coverage as a mechanism for long-term infant health and family stability.

Author

• Eunseo Kang, Calvin University
  Presenting Author