Figure 2. Change in the Physical Abuse and Neglect Rates Compared by State for 2013 vs 2016.

Physical abuse and neglect rates are expressed as cases per 100 000 children younger than 6 years. Negative changes indicate the rate decreased from 2013 to 2016. Louisiana did not expand Medicaid until July 2016 and is classified with the nonexpansion states in this analysis. For West Virginia (not included), the change in physical abuse rates is thought to be an outlier not due to an actual change but to data unreliability concerns possibly related to a change in 2014 to the Child Protective Services intake system.⁵⁶