State adoption of Medicaid 1915(c) waivers for children and youth with Autism Spectrum Disorder

Merryman, M. Beth; Miller, Nancy A.; Shockley, Emily; Eskow, Karen Goldrich; Chasson, Gregory S.

doi:10.1016/j.dhjo.2015.03.003

Cited by 11 publications

(7 citation statements)

References 13 publications

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“…Due to budget constraints or other limitations, a state may not implement an approved waiver or may not implement the waiver to the extent indicated on the CMS application. Often waivers are not fully funded by states or may actually serve far fewer children than expected . Further, we were unable to directly observe the effect waivers have on unmet need, as the survey data did not include information on whether or not a child with ASD was enrolled in a waiver.…”

Section: Discussionmentioning

confidence: 99%

“…Often waivers are not fully funded by states or may actually serve far fewer children than expected. 43 Further, we were unable to directly observe the effect waivers have on unmet need, as the survey data did not include information on whether or not a child with ASD was enrolled in a waiver. Finally, we were unable to account for all waivers that may have provided benefits to children with ASD, as our study only included waiver information for 1915(c) waivers that expressly included children with ASD in their target population.…”

Section: Discussionmentioning

confidence: 99%

“…Yet not all states have adopted such waivers, and in states that have adopted waivers, the characteristics of waivers vary substantially across states. A survey of state Medicaid directors found that states that have not implemented ASD‐specific waivers and do not perceive a need to do so felt that children with ASD were already provided adequate coverage through existing Medicaid benefits; however, most state Medicaid plans do not cover services such as physical and occupational therapy or behavior modification, commonly used to address the impairments associated with ASD …”

Section: Discussionmentioning

confidence: 99%

“…Abbreviation: ASD, autism spectrum disorder.substantially across states. A survey of state Medicaid directors found that states that have not implemented ASD-specific waivers and do not perceive a need to do so felt that children with ASD were already provided adequate coverage through existing Medicaid benefits;43 however, most state Medicaid plans do not cover services such as physical and occupational therapy or behavior modification, commonly used to address the impairments associated with ASD 44. In July 2014, the Centers for Medicaid and CHIP Services issued a bulletin clarifying the role of Medicaid waivers for children with ASD 45.…”

mentioning

confidence: 99%

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The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

LaClair

Mandell

Dick

et al. 2019

Health Services Research

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Objective To examine the effects of Medicaid Home and Community‐based Services (HCBS) waivers on reducing racial/ethnic disparities in unmet need for services among families of children with autism spectrum disorder (ASD). Data Sources Data from the 2003, 2007, and 2011 waves of the National Survey of Children's Health and the 2005 and 2010 waves of the National Survey of Children with Special Health Care Needs were used. Data on waiver characteristics were collected from source materials that were submitted in support of each state's waiver application. Waiver characteristics were combined to create a single waiver generosity variable. Study Design Quasi‐difference‐in‐difference‐in‐difference models were used to determine the effect of waiver generosity on racial/ethnic disparities in unmet need among children with ASD. Principal Findings Increased waiver generosity was associated with significantly reduced odds of having unmet need for black children with ASD compared with white children with ASD. Unmet needs among black children with ASD were roughly cut in half, a 13 percentage point decrease, with the implementation of an average generosity waiver. No significant differences were seen for Hispanic ethnicity. Conclusion These findings suggest that Medicaid HCBS waivers have the potential to ameliorate disparities in unmet need among children with ASD. Future policy development should focus on replicating the most effective characteristics of these waivers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

LaClair

Mandell

Dick

et al. 2019

Health Services Research

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“…Until recently, ASD services in the US had traditionally been covered by Medicaid and not private insurances (Kelly, 2015; Peele, Lave, & Kelleher, 2002). While Medicaid may provide autism coverage for children with ASD through Home and Community Based Services waiver programs under section 1915(c) of the Social Security Act (Merryman, Miller, Shockley, Eskow, & Chasson, 2015; Velott et al, 2015; Wang & Leslie, 2010), the waiver programs usually have a low quota resulting in many children with ASD being placed on a waitlist, unable to receive the ASD services they need (Eskow, Pineles, & Summers, 2011).…”

Section: Introductionmentioning

confidence: 99%

Changes in healthcare expenditures after the autism insurance mandate

Wang

Dholakia

et al. 2019

Research in Autism Spectrum Disorders

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Background: In recent years, most U.S. states have passed autism mandates requiring private insurers to cover autism spectrum disorders (ASD). Little is known about the post-mandate changes in healthcare expenditures. Method: This study utilized 2006–2012 de-identified insurance claims data from the largest insurer in Pennsylvania (PA), where the mandate went into effect in 2009. Healthcare expenditures were defined as the amount the insurer paid for healthcare services and were adjusted to 2012 price level. A mixed model approach was used to analyze the expenditures. Results: A total of 9,471 children with ASD were included in the study. Although the pre-mandate total expenditures per child with ASD were similar, the post-mandate expenditures significantly increased for groups subject to the autism mandate (87% increase from $7,754 in 2008 to $14,486 in 2010) compared to the exempt groups (27% increase from $7,238 to $9,171). By insurance type, the change from 2008 to 2010 in ASD-related expenditures per child with ASD was $8,439 for fully insured large employer sponsored plans and $43 for the Children’s Health Insurance Program (CHIP), both subject to the PA mandate; and $2,631 for the self-insured, $980 for small-employers, and $−92 for individual plans, all of which are exempt from the mandate. These increases were due to outpatient services but not inpatient or drug costs. Conclusions: Healthcare expenditures increased significantly following the PA autism mandate. Nonexempt, large employer groups had the largest increase in spending. Some exempt, self-insured companies may have voluntarily covered ASD services, leading to a moderate increase.

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State Approaches to Funding Home and Community-Based Mental Health Care for Non-Medicaid Youth: Alternatives to Medicaid Waivers

Graaf

Snowden

2019

Adm Policy Ment Health

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State adoption of Medicaid 1915(c) waivers for children and youth with Autism Spectrum Disorder

Cited by 11 publications

References 13 publications

The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

The effect of Medicaid waivers on ameliorating racial/ethnic disparities among children with autism

Changes in healthcare expenditures after the autism insurance mandate

State Approaches to Funding Home and Community-Based Mental Health Care for Non-Medicaid Youth: Alternatives to Medicaid Waivers

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