State Medicaid spending and financial burden of families raising children with autism.
Higher state Medicaid spending on kids with disabilities means parents of children with autism keep more money in their own pockets.
01Research in Context
What this study did
Goodwin et al. (2012) looked at state Medicaid budgets and family bank accounts. They asked: when a state spends more Medicaid money per child with disabilities, do moms and dads pay less themselves?
The team compared all 50 states. They used public budget data and parent surveys about autism costs.
What they found
States that put extra Medicaid dollars toward kids with disabilities had families who reported lighter out-of-pocket bills for their child with autism. More state money, less family money.
The link stayed strong even after adjusting for each state's wealth and cost of living.
How this fits with other research
Ohan et al. (2015) extends the same story to private insurance. That later study shows families with employer plans are five times more likely to face big out-of-pocket costs than families on Medicaid. Together the two papers paint a clear picture: public spending shields families; private plans often don’t.
Cidav et al. (2014) explains one way the shield works. They tracked Medicaid waiver programs and found higher waiver spending cuts expensive hospital stays and pushes care into outpatient clinics. Those shifts lower both state and family costs, backing up the 2012 burden finding with real service-use data.
Reyer et al. (2006) is the earlier snapshot. It first showed kids with autism already cost Medicaid ten times more than other kids, mostly from psychiatric hospital stays. Goodwin et al. (2012) builds on that by asking who feels the pain when those high bills arrive: the state budget or the kitchen-table budget.
Why it matters
If you write treatment plans or advocate for clients, know that state policy is a clinical variable. Push for Medicaid waiver slots, higher fee schedules, or expanded EPSDT in your state. When public funding grows, families free up cash for co-pays on your recommended ABA hours, special diets, or respite care. Track your state's per-child Medicaid spending and use these data in public-comment letters or insurance-authorization appeals. Strong budgets don't just help bureaucrats—they help the parents sitting across from you in therapy meetings.
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Add a line to your intake form asking what Medicaid waiver programs the family has tried, and offer to help them apply if none.
02At a glance
03Original abstract
We examined the association between state Medicaid spending for children with disabilities and the financial burden reported by families of children with autism. Child and family data were from the 2005-2006 National Survey of Children with Special Health Care Needs (n = 2,011 insured children with autism). State characteristics were from public sources. The 4 outcomes included any out-of-pocket health care expenditures during the past year, expenditure amount, expenditures as a proportion of family income, and whether additional income was needed to care for a child. We modeled the association between state per capita Medicaid spending for children with disabilities and families' financial burden, controlling for child, family, and state characteristics. Overall, 78% of families raising children with autism had health care expenditures for their child for the prior 12 months; 42% reported expenditures over $500, with 34% spending over 3% of their income. Families living in states with higher per capita Medicaid spending for children with disabilities were significantly less likely to report financial burden. There is a robust relationship between state Medicaid spending for children with disabilities and the financial burdens incurred by families raising children with autism.
Intellectual and developmental disabilities, 2012 · doi:10.1352/1934-9556-50.06.441