Child maltreatment underreported in Medicaid claims, study finds

Brown School's Raghavan says more data sets need to be examined to determine true scope of problem

Medicaid claims are a poor way to identify child abuse and neglect at a population level, according to a study from the Brown School at Washington University in St. Louis.


Lead author Ramesh Raghavan, PhD, associate professor at the Brown School and of psychiatry at the School of Medicine, examined Medicaid records from 36 states
for 1,921 children in the National Survey of Child and Adolescent
Well-Being, whom caseworkers had identified as having been maltreated,
and who had received Medicaid-funded services.

Only 15 percent had
relevant codes for abuse or neglect in any of their Medicaid files over
four years of observation.

Maltreated children are frequent users of health and mental health services; almost all are entitled to Medicaid.

Medicaid records of maltreated boys, older children, and African Americans were less likely to reflect abuse than those of other children, the study found.

Previous research has documented the reasons clinicians may not enter maltreatment codes while billing Medicaid, but the magnitude at a national level has not been known.

“This study has important implications for Medicaid scholarship conducted on abused and neglected children,” said Raghavan, who also is a faculty scholar in the Institute for Public Health. “It seems clear that relying upon Medicaid claims yields unacceptably low rates of ascertained maltreatment.”

Instead, he said, researchers should include data from child welfare or other administrative data sets to better capture the prevalence of abuse or neglect at a population level.

The study was published online in the August issue of Child Maltreatment.

Co-authors include Derek S. Brown, PhD, assistant professor at the Brown School and a scholar in the Institute for Public Health; Lauren D. Garfield, PhD, postdoctoral research scholar in the Department of Psychiatry; Raven E. Ross, doctoral student at Brown; Benjamin T. Allaire of RTI International; and Donald Hedeker, PhD, of University of Illinois, Chicago.