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State mandates increase access to autism care for insured children
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Insurance mandates enacted in 46 states that require commercial insurers to cover treatment for children with autism spectrum disorder were associated with increases in insurer-covered autism care and monthly spending on autism-specific services, according to data published in Health Affairs.
“The costs of caring for children with autism spectrum disorder, or ASD, can be substantial, and families of such children report challenges in paying for services,” Colleen L. Barry, PhD, MPP, the Fred and Julie Soper Professor and chair of the department of health policy and management at the Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “State enactment of autism mandates has been viewed as a strategy to broaden access to ASD treatment paid for via commercial insurance. To date, little is known about the effects of autism mandates.”
Researchers analyzed data from three nationwide private health insurers — United Healthcare, Aetna and Humana — from 2008 through 2012 to determine whether implementing autism mandates impacted service use or spending among commercially insured children with ASD. They compared children aged 21 years or younger who were eligible for mandates with children who were not eligible, measuring monthly service use and spending for all ASD-specific services, outpatient ASD-specific services and outpatient ASD-specific behavioral and functional therapies.
On average, mandates were associated with a 3.4% increase in monthly use and a $77 increase in monthly spending on ASD-specific services. Analysis showed that the associated total ASD-related health care spending was higher by approximately $924 per year for children covered by mandates, mainly through increased spending on outpatient services instead of hospitalizations. Researchers observed greater increases in care and associated spending for children with ASD aged younger than 12 years, with the highest concentration of increases seen among those aged 5 years and younger. These effects increased with the number of years since mandate implementation.
“Spending increases on outpatient services of this size mean that kids are receiving many more services per year paid for by private insurance — these changes due to the mandates are big enough to make a real difference in these children’s lives,” Barry said in a press release. “The hope of patient advocates and policymakers was that these insurer mandates would increase care for children with autism, and they seem to have done that — in fact, the impact was even larger than we had expected. The findings from this study can influence the debate in states that are thinking about expanding the scope of their laws by covering more children, especially those considering expanding their age eligibility to cover older children and those transitioning into adulthood.” – by Savannah Demko
Disclosures: Barry reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.
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