The 2005 TennCare Disenrollments Increased Rates of Intimate Partner Violence: Insights for the Post-COVID Medicaid Unwinding.

Abstract

Objective: To quantify the impact of 2005 TennCare mandatory disenrollment on intimate partner violence (IPV).

Study setting and design: Using 2005 TennCare mandatory disenrollment as a quasi-natural experiment, we classified counties with pre-reform TennCare enrollment rates above the median as high-exposure (treated group) and those below the median as low-exposure (control group). We employed a doubly robust Difference-in-Differences design that compares the high-exposure counties with the low-exposure counties before and after the TennCare disenrollment, adjusting for various county-level characteristics. We performed a dose-response DID model using the pre-reform TennCare enrollment rates as a continuous treatment for robustness checks.

Data sources and analytic sample: We extracted IPV incidents from 2003 to 2008 National Incident-Based Reporting System, supplemented with data from Surveillance, Epidemiology, and End Results program and Area Health Resource Files. We aggregated IPV incidents by police agency, year, and quarter to create an aggregate-level count of IPV per 10,000 population. The analytic sample consists of 6780 agency-year-quarter observations.

Principal findings: Our findings revealed that TennCare disenrollment led to an increase of 4.8 (95% CI: 0.90-8.6) IPV incidents per 10,000 population, approximately a 25.8% (95% CI: 4.9%-46.7%) increase. This impact was more salient among younger adults and women. Importantly, the disenrollment led to a significantly larger increase in drug-related IPV incidents. Our welfare calculation shows that the disenrollment resulted in a total economic burden of approximately $232.34 (95% CI: 43.95-420.94) million, with the government bearing $86.66 (95% CI: 16.39-157) million of this cost.

Conclusions: This study underscores the importance of considering broader social costs associated with abrupt loss of insurance coverage. These findings support the need for Medicaid reforms that incorporate safety measures to prevent unintended social harms and support the well-being of economically vulnerable populations.