Healthcare service use and costs for autism spectrum disorder: a comparison between medicaid and private insurance.
Medicaid still buys more therapy visits than private insurance—plan accordingly.
01Research in Context
What this study did
Wang et al. (2013) compared insurance records for kids with autism.
They looked at kids with Medicaid and kids with private plans.
The team counted therapy visits and total money paid.
What they found
Medicaid paid about four times more per child.
Kids on Medicaid also had more therapy visits.
Private plans covered fewer sessions and spent less overall.
How this fits with other research
Zhang et al. (2022) asked parents nine years later.
Even after autism reform laws, private families still said coverage was worse.
The gap shrank a little, but the pattern stayed the same.
Loughrey et al. (2014) showed why: parent stress, race, and rural zip codes add extra barriers on top of insurance type.
Why it matters
Use these numbers when you write treatment plans or talk to funders.
If a child has private insurance, expect fewer approved hours.
Add extra time to teach parents how to fight denials or find public options.
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02At a glance
03Original abstract
Healthcare costs and service use for autism spectrum disorder (ASD) were compared between Medicaid and private insurance, using 2003 insurance claims data in 24 states. In terms of costs and service use per child with ASD, Medicaid had higher total healthcare costs ($22,653 vs. $5,254), higher ASD-specific costs ($7,438 vs. $928), higher psychotropic medication costs($1,468 vs. $875), more speech therapy visits (13.0 vs. 3.6 visits), more occupational/physical therapy visits (6.4 vs. 0.9 visits), and more behavior modification/social skills visits (3.8 vs. 1.1 visits) than private insurance (all p < 0.0001). In multivariate analysis, being enrolled in Medicaid had the largest effect on costs, after controlling for other variables. The findings emphasize the need for continued efforts to improve private insurance coverage of autism.
Journal of autism and developmental disorders, 2013 · doi:10.1007/s10803-012-1649-y