Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

Abstract

Forty-six states and the District of Columbia have enacted insurance mandates that require commercial insurers to cover treatment for children with autism spectrum disorder (ASD). This study examined whether implementing autism mandates altered service use or spending among commercially insured children with ASD. We compared children age twenty-one or younger who were eligible for mandates to children not subject to mandates using 2008-12 claims data from three national insurers. Increases in service use and spending attributable to state mandates were detected for all outcomes. Mandates were associated with a 3.4-percentage-point increase in monthly use and a $77 increase in monthly spending on ASD-specific services. Effects were larger for younger children and increased with the number of years since mandate implementation. These increases suggest that state mandates are an effective tool for broadening access to autism treatment under commercial insurance.

Keywords: Children’s Health; Insurance; Mental Health/Substance Abuse; Special Populations.

EXHIBIT 3:. Adjusted estimates of state mandates’ effects on mean monthly spending among children with autism spectrum disorder (ASD), by age group, 2008–12

SOURCE Authors’ analysis of inpatient, outpatient, and pharmaceutical commercial claims data from the Health Care Cost Institute. NOTES The exhibit shows difference-in-differences estimates. All results for ages 0–5 and 6–12 are significantly different from zero (p < 0.05). Full results, including difference-in-differences estimates, are in Appendix H (see Note 23 in text). Adjusted analyses include child-level control variables and state and year fixed effects.

Exhibit 4:. Adjusted estimates of mean monthly spending on autism spectrum disorder–specific treatment services, by number of years after mandate implementation and children’s mandate eligibility, 2008–12

SOURCE Authors’ analysis of inpatient, outpatient, and pharmaceutical commercial claims data from the Health Care Cost Institute. NOTES Quantities shown are mean spending levels. Full results, including difference-in-differences estimates, are in Appendix I (see Note 24 in text). Adjusted analyses include child-level control variables and state and year fixed effects.