Access and service use by children with autism spectrum disorders in Medicaid Managed Care.
Medicaid managed care served only one-tenth of autistic children and cut service days by 40%, a gap that later studies show has not closed.
01Research in Context
What this study did
Nevin et al. (2005) tracked every Medicaid record for kids with autism in one state. They counted who got behavioral health care, how many days each child used, and what kinds of services were given. The study ran before most kids had ABA insurance, so it shows the baseline safety-net picture.
What they found
Only one in ten expected children with autism actually saw any behavioral health service. Total service days per child fell 40% during the study window. Day-treatment classrooms disappeared while prescriptions and case-management visits rose.
How this fits with other research
The same gap shows up today. Chee et al. (2017) surveyed Canada and found only 70% of priority needs met across the lifespan, proving the shortfall is not just a U.S. Medicaid problem.
Rubenstein et al. (2019) looked at preschoolers with public insurance and saw 40% still receive zero community services, extending the 2005 finding to a younger group.
Frazier et al. (2023) added COVID-19 shock: ABA hours dropped 11 per month, showing the system remains fragile. Together the papers trace one long access drought from 2005 to 2023.
Why it matters
If you write treatment plans for Medicaid clients, assume the family has already waited years for care. Front-load parent training and use group formats to stretch the few authorized hours. Track authorizations closely; managed care still replaces therapy with medication when hours run out.
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02At a glance
03Original abstract
Although Medicaid is the largest public payer of behavioral health services, information on access and utilization of services is lacking, and no data on the frequency of service use or types of services provided for children with autism spectrum disorders (ASDs) are available. As states move toward managed care approaches for their Medicaid program, services information is critical. Behavioral health service data for children with autism spectrum disorders were collected from a state Medicaid Managed Care (MMC) program and analyzed from fiscal years 1995 through 2000. Findings revealed that the number of children who received services over time increased significantly; however, the rate of service use was only one tenth of what should be expected based on prevalence rates. The mean number of service days provided per child decreased significantly, about 40%, and the most prevalent forms of treatment changed. Day treatment vanished and medication and case management increased disproportionately to the number of children served. Explanations and implications of the findings are presented as well as recommendations for future research.
Journal of autism and developmental disorders, 2005 · doi:10.1007/s10803-004-1026-6