Association Between Medicaid Waivers and Medicaid Disenrollment Among Autistic Adolescents During the Transition to Adulthood

Carey, Meghan E; Tao, Sha; Miller, Kaitlin H. Koffer; Marcus, Steven C.; Mandell, David S.; Epstein, Andrew J.; Shea, Lindsay

doi:10.1001/jamanetworkopen.2023.2768

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…Cumulatively, this suggests that changes to waivers that ensure adequate coverage for autistic people without co-occurring ID and ensure continuity in waivers across the lifespan could be an effective approach to mitigate these disruptions to Medicaid coverage. The greatest probability of ID diagnosis accrual among our sample occurred between ages 19 (for those with disruptions) and 21 (for both groups), which coincides with when autistic young adults are reassessed for Medicaid eligibility as an individual rather than a family (age 19), and when most states terminate education system supports (age 21), and disenrollment peaks observed in prior studies (Carey et al, 2023;Shea et al, 2022). Threats to continuous healthcare coverage among those in need of services and supports have significant downstream consequences and may contribute to increased levels of unmet health needs among autistic adults (Turcotte et al, 2016).…”

Section: Discussionsupporting

confidence: 69%

Short report on navigating access to care for Medicaid-enrolled autistic youth and young adults: Examining accrual of intellectual disability diagnoses in adolescence

Carey

Ardeleanu

Marcus

et al. 2023

Autism

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Medicaid is a major insurer of autistic people. However, during the transition to adulthood, autistic individuals are more likely than people with intellectual disability to lose their Medicaid benefits. Individuals with intellectual disability may have greater success maintaining Medicaid coverage during this time because most states provide coverage to individuals with intellectual disability throughout adulthood, which is not the case for autism. Using national Medicaid data from 2008 to 2016, we estimated the probability of intellectual disability diagnosis accrual among autistic Medicaid beneficiaries. Medicaid beneficiaries ages 8 to 25 with 1+ inpatient or 2+ outpatient autism spectrum disorder claims, but no intellectual disability claim, in a 12-month eligibility period were included. We used a person-month discrete-time proportional hazards model. Disruptions in Medicaid coverage were operationalized as 2+ consecutive months of no coverage before coverage resumed (yes/no). One in five autistic individuals ages 8–25 accrued an intellectual disability diagnosis. The probability of accruing an intellectual disability diagnosis was higher among autistic individuals who had disruptions in Medicaid coverage compared to those without disruptions, and peaked at age 21 (during the transition to adulthood). Expanding Medicaid to cover autistic people of all ages could decrease the need for intellectual disability diagnosis accrual and improve health outcomes for autistic adults. Lay abstract What is known? In most states, Medicaid waivers provide individuals with an intellectual disability diagnosis generous healthcare coverage throughout adulthood. By comparison, fewer Medicaid programs are available for autistic individuals, and they are more likely to experience disruptions, or gaps, in Medicaid coverage and subsequently not re-enroll. What this paper adds? One in five autistic individuals with Medicaid coverage between ages 8 and 25 accrued a new intellectual disability diagnosis. The probability of a new intellectual disability diagnosis was higher among those who had previous disruptions in Medicaid coverage. Implications for research and policy. Expanding Medicaid to cover autistic people of all ages could decrease the need for intellectual disability diagnosis accrual. Input from autistic individuals and their families regarding their health insurance access and healthcare experiences is critically important to understanding next steps for research.

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Section: Discussionsupporting

confidence: 69%

Short report on navigating access to care for Medicaid-enrolled autistic youth and young adults: Examining accrual of intellectual disability diagnoses in adolescence

Carey

Ardeleanu

Marcus

et al. 2023

Autism

Self Cite

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show abstract

“…In the Research Letter titled “Association Between Medicaid Waivers and Medicaid Disenrollment Among Autistic Adolescents During the Transition to Adulthood,” 1 published March 13, 2023, certain percentages that appeared in the first paragraph of the Results did not match the corresponding percentages in the Table. This article has been corrected.…”

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confidence: 99%

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2023

JAMA Netw Open

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Brief Report: Under-Identification of Symptomatic Menopause in Publicly-Insured Autistic People

Benevides,

Cook,

Klinger

et al. 2024

J Autism Dev Disord

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Association Between Medicaid Waivers and Medicaid Disenrollment Among Autistic Adolescents During the Transition to Adulthood

Abstract: This cohort study examines whether Medicaid waivers were associated with a reduced risk of Medicaid disenrollment among autistic adolescents who are transitioning to adulthood.

Cited by 4 publications

References 7 publications

Short report on navigating access to care for Medicaid-enrolled autistic youth and young adults: Examining accrual of intellectual disability diagnoses in adolescence

Short report on navigating access to care for Medicaid-enrolled autistic youth and young adults: Examining accrual of intellectual disability diagnoses in adolescence

Errors in Results

Brief Report: Under-Identification of Symptomatic Menopause in Publicly-Insured Autistic People

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