Prevalence and Correlates of School-Based Medicaid-Funded Services for Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects as many as 1 in 68 U.S. children.1 Characterized by communication difficulties, social interaction impairments, and restricted patterns of behavior, children with ASD often require a variety of developmental services and supports, including speech-language therapy, occupational therapy, and behavioral health services, in order to meet their needs. 2 Children with ASD often receive these services in school-based setting, as specified by the child’s individualized education plan (IEP) or in community-based settings. For low-income and severely disabled children with ASD, the Medicaid program serves a key role in financing these services. Because each state administers its own Medicaid program through a federal-state partnership, there are a variety of different financing models for delivering developmental services to children with ASD. A majority of Medicaid insured children are enrolled in managed care health plans, whereby the child receives most of their health care from a set of “in-network” providers. However, while Medicaid managed care (MMC) is most commonly used to finance community-based services, school-based health services are overwhelmingly financed on a fee-for-service (FFS) basis.3 In fact, only four states use a payment methodology other than FFS (i.e. bundled payment) for financing school-based services. While there is a growing body of literature examining the effects of managed care on health service use and expenditures, little is known about the effect of MMC on children with ASD. Even less is known about the interplay of FFS and MMC on service use and total expenditures for children with ASD. Thus, the goal of this project is to examine the relationship between state and county-level Medicaid payment methodologies and the rates of service utilization and expenditures for school-based Medicaid funded health services for children with ASD. Medicaid claims data from 47 states and the District of Columbia will be analyzed to identify the impact of different payment methodologies on outcomes. Our project will shed light on the interplay between community-based and school-based service payment methodologies and lay the groundwork for a future application to study the effect of such arrangements on total Medicaid expenditures for this population over time. The time is right to examine Medicaid funded services for children with ASD because the Affordable Care Act has given states more options to expand services including key evidence based-behavioral interventions.4