Assessing early implementation of state autism insurance mandates

Baller, Julia; Barry, Colleen L.; Shea, Kathleen L.; Walker, Megan M.; Ouellette, Rachel R.; Mandell, David S.

doi:10.1177/1362361315605972

Cited by 26 publications

(23 citation statements)

References 13 publications

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“…Our finding regarding the effects of waivers on black‐white disparities stands in contrast to findings from studies of states’ autism insurance mandates that require private insurance plans to cover ASD assessment and treatment . Despite evidence that these mandates result in increased diagnosis of ASD, they have not been found to affect racial disparities in parent‐reported outcomes .…”

Section: Discussioncontrasting

confidence: 97%

“…33 Our finding regarding the effects of waivers on black-white disparities stands in contrast to findings from studies of states' autism insurance mandates that require private insurance plans to cover ASD assessment and treatment. 34 Despite evidence that these mandates result in increased diagnosis of ASD, 35 they have not been found to affect racial disparities in parent-reported outcomes. 36 Medicaid HCBS waivers may have more effect on racial disparities among children with ASD than private insurance mandates because Medicaid-enrolled children with ASD use more services than those with private insurance, 37 providing them with more opportunities to receive care perceived as needed.…”

Section: Discussionmentioning

confidence: 99%

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The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

LaClair

Mandell

Dick

et al. 2019

Health Services Research

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Objective To examine the effects of Medicaid Home and Community‐based Services (HCBS) waivers on reducing racial/ethnic disparities in unmet need for services among families of children with autism spectrum disorder (ASD). Data Sources Data from the 2003, 2007, and 2011 waves of the National Survey of Children's Health and the 2005 and 2010 waves of the National Survey of Children with Special Health Care Needs were used. Data on waiver characteristics were collected from source materials that were submitted in support of each state's waiver application. Waiver characteristics were combined to create a single waiver generosity variable. Study Design Quasi‐difference‐in‐difference‐in‐difference models were used to determine the effect of waiver generosity on racial/ethnic disparities in unmet need among children with ASD. Principal Findings Increased waiver generosity was associated with significantly reduced odds of having unmet need for black children with ASD compared with white children with ASD. Unmet needs among black children with ASD were roughly cut in half, a 13 percentage point decrease, with the implementation of an average generosity waiver. No significant differences were seen for Hispanic ethnicity. Conclusion These findings suggest that Medicaid HCBS waivers have the potential to ameliorate disparities in unmet need among children with ASD. Future policy development should focus on replicating the most effective characteristics of these waivers.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussionmentioning

confidence: 99%

The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

LaClair

Mandell

Dick

et al. 2019

Health Services Research

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“…21 For example, children with higher levels of spending may have families with additional disposable income to pay for services, or children with lower levels of spending may reside in areas with limited provider supply 22 or have families that are less capable of advocating for their needs or are uncertain about which services are covered. 23 Such disparities could be exacerbated when ASD mandates are enacted.…”

Section: Discussionmentioning

confidence: 99%

Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder

et al. 2019

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BACKGROUND:The health care costs associated with treating autism spectrum disorder (ASD) in children can be substantial. State-level mandates that require insurers to cover ASDspecific services may lessen the financial burden families face by shifting health care spending to insurers. METHODS:We estimated the effects of ASD mandates on out-of-pocket spending, insurer spending, and the share of total spending paid out of pocket for ASD-specific services. We used administrative claims data from 2008 to 2012 from 3 commercial insurers, and took a difference-in-differences approach in which children who were subject to mandates were compared with children who were not. Because mandates have heterogeneous effects based on the extent of children's service use, we performed subsample analyses by calculating quintiles based on average monthly total spending on ASD-specific services. The sample included 106 977 children with ASD across 50 states. RESULTS:Mandates increased out-of-pocket spending but decreased the share of spending paid out of pocket for ASD-specific services on average. The effects were driven largely by children in the highest-spending quintile, who experienced an average increase of $35 per month in out-of-pocket spending (P < .001) and a 4 percentage point decline in the share of spending paid out of pocket (P < .001).CONCLUSIONS: ASD mandates shifted health care spending for ASD-specific services from families to insurers. However, families in the highest-spending quintile still spent an average of >$200 per month out of pocket on these services. To help ease their financial burden, policies in which children with higher service use are targeted may be warranted. abstract NIH

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“…Many of the granular policy variations across states are lost from such analyses due to the independent variable being rolled up into a single categorical variable; for example, a state law is present or not present (e.g., Parish, Thomas, Rose, Kilany, & McConville, 2012). Even where more granular policy provisions are studied, the methods used to collect and assess the laws of interest remain unclear (Baller et al., 2016; Chatterji, Decker, Markowitz, 2015). Studying the variation in specific provisions may provide greater context for measuring the impact of the laws on specific outcomes (Johnson et al, 2014).…”

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confidence: 99%

Analyzing State Autism Private Insurance Mandates for Allied Health Services: A Pilot Study

Douglas

Benevides

Carretta

2017

OTJR: Occupation, Participation and Health

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Due to the prevalence, severity, and costs associated with autism spectrum disorders (ASDs), it has become a public health issue. In response, state governments have adopted ASD-specific private insurance mandates requiring coverage of ASD screening, diagnosis, and treatment. Despite rapid uptake of these laws, differences exist in the type and levels of coverage, especially for allied health services including occupational therapy. We piloted a structured legal research methodology to code ASD insurance mandates that impact allied health service provisions. State private insurance mandates were obtained from WestlawNext. A coding methodology was piloted on 14 states and included variables for age and service limits, treatments covered, and medical necessity. Coding methods were feasible and highly reliable among raters. Ten of 12 states had a coverage mandate, many with specific provisions for allied health providers. A full analysis of all 50 states is warranted to identify provisions affecting allied health providers serving individuals with ASD.

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Assessing early implementation of state autism insurance mandates

Cited by 26 publications

References 13 publications

The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder

Analyzing State Autism Private Insurance Mandates for Allied Health Services: A Pilot Study

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