Changes in spending and service use after a state autism insurance mandate.
State autism insurance mandates can more than double outpatient therapy use, but gains stay limited to insured families in wealthier states.
01Research in Context
What this study did
Kansas passed a 2011 law that made private insurers pay for autism treatment.
The authors pulled insurance claims for the kids with autism before and after the law.
They compared spending and therapy visits two years before to two years after.
What they found
Total dollars spent on each child almost doubled.
Out-of-pocket costs for families also rose, but only by about one quarter.
Most important, outpatient therapy visits more than doubled after the mandate.
How this fits with other research
Laugeson et al. (2014) warned that mandates like Kansas land in states that already have money. Their map shows poor, rural states still lack these laws. The Kansas numbers look great, yet only families with private insurance in one better-off state gained.
Titlestad et al. (2019) asked college students with autism what help they still need. Many wanted one-to-one coaching. The Kansas kids who got extra therapy years ago are now those young adults; the mandate gave them a head start, but supports must keep going after high school.
Pinborough-Zimmerman et al. (2012) found that half of kids with a medical autism label never get the school autism label. More therapy slots from insurance are good, but you still need to watch both health and school records so kids do not fall through the cracks.
Why it matters
If you practice in a mandate state, expect more clients and longer authorizations. Use the law to ask for extra hours or parent training. If you practice in a non-mandate state, show families this Kansas data when you testify for local legislation. More funding really does turn into more therapy time.
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02At a glance
03Original abstract
Almost all states have insurance coverage mandates for childhood autism spectrum disorder treatment, yet little is known about how mandates affect spending and service use. We evaluated a 2011 Kansas law mandating comprehensive coverage of autism spectrum disorder treatments in the State Employee Health Plan. Data were extracted from the Kansas All-Payer Claims Database from 2009 to 2013 for enrollees of State Employee Health Plan and private health plans. The sample included children aged 0-18 years with >2 claims with an autism spectrum disorder diagnosis insured through State Employee Health Plan or a comparison group enrolled through private health plans. We estimated differences-in-differences regression models to compare trends among State Employee Health Plan to privately insured children. Average annual total spending on autism spectrum disorder services increased by US$912 (95% confidence interval: US$331-US$1492) and average annual out-of-pocket spending on autism spectrum disorder services increased by US$138 (95% confidence interval: US$53-US$223) among diagnosed children in the State Employee Health Plan relative to the comparison group following the mandate, representing 92% and 75% increases over baseline total and out-of-pocket autism spectrum disorder spending, respectively. Average annual quantity of outpatient autism spectrum disorder services increased by 15.0 services (95% confidence interval: 8.4-21.6) among children in the State Employee Health Plan, more than doubling the baseline average. Implementation of a comprehensive autism spectrum disorder mandate in the Kansas State Employee Health Plan was associated with substantial increases in service use and spending for autism spectrum disorder treatment among autism spectrum disorder-diagnosed children.
Autism : the international journal of research and practice, 2019 · doi:10.1177/1362361317728205