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

Abstract

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.

Co‐occurring conditions and racial‐ethnic disparities: Medicaid enrolled adults on the autism spectrum

“…To address these disparities, several public health interventions have been proposed, such as social support, surveillance and research, cultural competency programs, and evidence‐based and community‐defined approaches (Primm et al, 2010). In the context of state Medicaid programs, approaches such as managed care (Marton et al, 2016), more generous home and community based services waivers (LaClair et al, 2019), and Medicaid expansion (Xiao et al, 2018) have shown potential for reducing disparities. Additional approaches tailored to state Medicaid programs, with access via eligibility criteria/processes and service delivery, are likely needed to further reduce disparities.…”

States' use of Medicaid to meet the needs of autistic individuals

“…13 Over the last two decades, many states have changed their Medicaid programs 11 in response to the 30-fold increase in the reported prevalence [16][17][18][19][20] in addition to reported needs across the lifespan 21,22 of autistic individuals, often by using waivers. Studies have found that waivers ameliorate health disparities among autistic children from underserved and underrepresented groups, 23 reduce parent workforce engagement barriers, 11 and improve children's quality of life and clinical trajectory. 24 Research to date has not specifically described these programs, has been cross-sectional, and has not included adults.…”

Faith and FACES: Black Parents’ Perceptions of Autism, Faith, and Coping

“…Despite increased diagnostic prevalence (e.g., Maenner et al, 2020; Nevison & Zahorodny, 2019), Black families raising children with autism still face unique barriers to accessing and utilizing services, including practitioner biases and community stigma (Dababnah et al, 2018; Howard et al, 2021; Pearson, Meadan et al, 2020). When compared to white children with autism, Black children with autism experience additional negative outcomes such as delayed communication and lower scores on cognitive and language measures (Blanchett et al, 2009; Donohue et al, 2017; LaClair et al, 2019; Pearson & Meadan, 2018). Black parents raising children with autism identified several barriers to accessing services unique to Black families.…”

“…For example, Black parents reported that primary healthcare providers ignored their early concerns about developmental delays in their child (Dababnah et al, 2018). Second, school personnel assumed a lack of parental competence (Dababnah et al, 2018; LaClair et al, 2019; Lovelace et al, 2018; Pearson & Meadan, 2018; Smith et al, 2020; Stanley, 2015). For example, rural Black mothers raising children with autism reported that education professionals dismissed or diminished mothers’ concerns about their child’s educational progress (Stanley, 2015).…”