Occupational Therapy Service Delivery Among Medicaid-Enrolled Children and Adults on the Autism Spectrum and With Other Intellectual Disabilities

Abstract

Importance: Rates of occupational therapy service utilization among people with autism spectrum disorder (ASD) or intellectual disability (ID) have not been explored in population-based samples. Objective: To describe occupational therapy services delivered to Medicaid-eligible persons younger than age 65 yr identified as having ASD, ID, or both and to evaluate demographic factors associated with occupational therapy service utilization in this population. Design: Retrospective, case–control, cohort study using claims records from Medicaid Analytic eXtract files (2009–2012). Setting: Data from all 50 states and Washington, DC. Participants: Beneficiaries identified as having ASD only, ASD+ID, or ID only who were younger than age 18 yr (N = 664,214) and ages 18–64 yr (N = 702,338). Outcomes and Measures: We analyzed Current Procedural Terminology® and Healthcare Common Procedure Coding System procedure codes, Medicaid Statistical Information System type of service codes, and Center for Medicare & Medicaid Services provider specialty codes. Results: Only 3.7% to 6.3% of eligible adult beneficiaries received occupational therapy; in contrast, 20.5% to 24.2% of children received occupational therapy. Significant predictors of service use varied by group; however, differences by race–ethnicity, eligibility on the basis of poverty, and geographic location were observed. Among children, the most frequent billing code was for “therapeutic activities” (43%–60%); among adults, it was “community/work reintegration training” (29%–39%). Conclusions and Relevance: Billed procedure code patterns do not consistently reflect the unique occupational focus that occupational therapy providers deliver to people with developmental disabilities. Disparities in occupational therapy receipt warrant further attention to understand the social and structural factors affecting service delivery. What This Article Adds: Occupational therapy services paid for by Medicaid are used more frequently by children with ASD and ID than by adults with these diagnoses. Greater understanding of the intersectional factors that drive service delivery and disparities is needed.

Evidence from the Autism Transitions Research Project (2017–2022): Capstone review and services research recommendations

“…Other notable aspects of the work not included in Table 1 capture issues of diversity and representation. Seven studies included an explicit focus on issues of equity based on race, ethnicity, gender, and income (Benevides et al, 2022; McGhee Hassrick et al, 2021; Roux et al, 2022; Schott et al, 2022a; Shattuck et al, 2020; Song, Nonnemacher, Miller, Anderson, & Shea, 2022; Song, Salzer, Nonnemacher, Miller, & Shea, 2022). One review article noted that under‐represented study participants included autistic individuals who were women, transgender, non‐White, low income, and those with intellectual disability or with minimal speaking communication (McGhee Hassrick et al, 2021).…”

“…In regard to the main findings of individual ATRP‐funded studies, results verified high rates of co‐occurring health and mental health conditions beginning in adolescence and use of polypharmacy (Kerns et al, 2020; Rast et al, 2021), along with utilization of emergency department and inpatient hospitalizations often related to psychiatric diagnoses (Rast et al, 2022; Schott et al, 2022b). Studies documented how autistic youth are less likely to have their health and mental health needs met or to have positive care experiences (Fernandes et al, 2021; Roux et al, 2022), and how drop‐offs in utilization of some services (speech therapy, occupational therapy, one‐on‐one supports) begin as early as high school (Benevides et al, 2022; Song, Salzer, Nonnemacher, & Shea, 2022). While case management and mental health service use increased in young adulthood, unmet service needs also increased during this period (Song, Salzer, Nonnemacher, & Shea, 2022).…”

“…Across domains (health, mental health, employment, etc. ), access, service use and outcomes varied by race/ethnicity, income, gender, and by intersections of these factors with autism diagnosis (Benevides et al, 2022; McGhee Hassrick et al, 2021; Roux et al, 2022; Schott et al, 2022a; Shattuck et al, 2020; Song, Nonnemacher, Miller, Anderson, & Shea, 2022; Song, Salzer, Nonnemacher, Miller, & Shea, 2022). Both service delivery and policy to support vocational programming varied widely across states with an evident lack of state planning for addressing the service needs of this growing population (Roux et al, 2019; Roux, Anderson, Rast, et al, 2018; Roux, Rast, Nye‐Lengerman, et al, 2018; Roux, Rast, & Shattuck, 2018).…”

“…Studies documented how autistic youth are less likely to have their health and mental health needs met or to have positive care experiences (Fernandes et al, 2021;Roux et al, 2022), and how drop-offs in utilization of some services (speech therapy, occupational therapy, one-on-one supports) begin as early as high school (Benevides et al, 2022;.…”

Health Services Research and Occupational Therapy: Ensuring Quality and Cost-Effectiveness

“…Two articles in this special issue focus on the utilization of occupational therapy services among specific populations to advance knowledge in this area. Benevides et al (2022) explored utilization of occupational therapy services among children and adults covered by Medicaid who are on the autism spectrum, have intellectual disability, or both. Their study found lower utilization of occupational therapy services among adolescents and adults compared with younger children and points to potential disparities in access to care by age, race and ethnicity, sex, and urbanicity.…”