Effects of State Autism Mandate Age Caps on Health Service Use and Spending Among Adolescents.

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TitleEffects of State Autism Mandate Age Caps on Health Service Use and Spending Among Adolescents.
Publication TypeJournal Article
Year of Publication2018
AuthorsKennedy-Hendricks, A, Epstein, AJ, Mandell, DS, Candon, MK, Marcus, SC, Xie, M, Barry, CL
JournalJ Am Acad Child Adolesc Psychiatry
Volume57
Issue2
Pagination125-131
Date Published2018 Feb
ISSN1527-5418
Abstract

OBJECTIVE: Many states with mandates requiring commercial insurers to cover autism spectrum disorder (ASD) health services specify upper age limits above which coverage is no longer mandated. It is unknown what effects these age caps have on health service use and spending among adolescents who have exceeded the age cap.

METHOD: Using administrative claims data from 3 national commercial insurers, a difference-in-differences approach was used to estimate effects of age caps on health service use and spending among adolescents with ASD. Statistical models compared changes in use and spending between those above versus below the age cap among individuals eligible versus ineligible for mandated coverage. The analytic sample included data from 2008 through 2012 on 7,845 individuals (151,976 person-months) ages 10 to 21 years in 11 states imposing mandate age caps going into effect during adolescence.

RESULTS: Age caps were associated with 4.2 percentage point (95% CI = -7.0, -1.5) lower probability of any ASD-specific service use in a month and $69 less (95% CI = -112, -$26) in average monthly spending on ASD-specific services than would have been expected given concomitant pre-post age cap differences among individuals in the same states who were never eligible for mandate-covered services. In addition, age caps were associated with $99 (95% CI = -$168, -$30) lower average monthly spending on all health care services.

CONCLUSION: Insurance mandates that include age caps going into effect during adolescence reduce health service use and spending among individuals with ASD during a critical phase of the life course.

DOI10.1016/j.jaac.2017.10.019
Alternate JournalJ Am Acad Child Adolesc Psychiatry
PubMed ID29413145
PubMed Central IDPMC5806145
Grant ListR01 MH096848 / MH / NIMH NIH HHS / United States