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Both ACES and Medicaid insurance are strongly correlated with poverty and low SES so, of course, there would be a strong relationship but it does not mean anything. ACES AWARE in California only promoted ACES screening in Medicaid patients. DM me to help reframe your question. I have access to lots of articles on poverty and ACES and how relief of poverty is good remediation.

I am in California where we have extensive Medicaid services but a very, very low payment scale so let me approach this relation as a "case study." I am a retired family doc. After I closed my personal practice I worked in a FQHC with about 100% Medicaid patients, mostly homeless. We had an in clinic psychiatrist (who could care less about ACES) and 4 therapists (MSW, psychologist or MFCC) who understood ACEs. In California (I was in San Diego) mental health services were "carved out" of the medical HMO system and given to a specific medical contractor group or provided by County Mental Health. Our clinic was in no way "trauma informed."
Treating ACES, in my opinion, requires relatively intensive, personalized cognitive behavioral therapy (see the California Evidence-Based Clearinghouse for Child Welfare (CEBC) set up to advance the effective implementation of evidence-based practices for children and families involved with the child welfare system) and cannot be done by medication or DSM symptom based therapy.
While our clinic therapists were excellent and competent and very helpful to me and my patients, our psychiatrists criticized me for not following their inadequate treatment plans and paying attention to ACES and TIC. Any care provided outside the clinic was essentially unreliable, third world, sporadic, medication management with little personal attention.
Because Medicaid  has almost universally has poor reembursement, and good mental health care requires time and effort with patients and the need for mental health care is huge, there are systematic unfixable deficiencies.
California has a unique "ACES Aware" project in our MediCal which has a more optimistic look at the situation and has initiated a system wide screening program (See attached) but has not published any treatment or outcome data.  Also go to its web site which has loads of resources (https://www.acesaware.org/about/  )
In many states adults who are not pregnant or do not have dependent children, may be poor and ill and suffering from child maltreatment trauma but they would not be eligible for Medicaid - a condition endured by my homeless patients before the ACA medicaid expansion.

I agree one hundred percent. Primary prevention is actually expanding through the Families First federal and state efforts. The evidence for economic and concrete family support is overwhelming. However, government investment in this area is severely limited by our nation's racism. Meanwhile there are many children and adults suffering from child maltreatment trauma. They need care now (tertiary prevention). Unfortunately Medicaid is all we have, so this discussion has been about how to use Medicaid to serve them.

Also unlike some European countries, we do not have a national health system, so there is no macro-policy or macro-budgeting system where money saved by decreasing the need for medical or mental health intervention can be reallocated to primary prevention. The return on investment if this was done is 3 to 10 times.

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