The Impact of the Passage of an Autism Mandate on Healthcare Utilization and Insurance Expenditures for Texas Children 3-9, 2006-2010 Open Access

Abstract

Autism spectrum disorders (ASD) are developmental disorders characterized by decreased social functioning. While they do not have a cure, they can be treated and managed using developmental therapies, including applied behavioral analysis (ABA). These developmental therapies can cost families without insurance coverage $40,000-$50,000 annually. To ensure health insurance companies cover these services, 38 states have passed autism mandates. This study uses Truven Marketscan administrative claims data from 2006-2010 for all children in Texas between the ages of 3 and 9 with ASD to examine the impact of a mandate passed by the state of Texas in 2008. To determine the impact of the legislation, we utilized a pre-post, non-equivalent group design to exploit the policy change. We ran two-part models to examine the impact of legislation on the probability of using key services and the number annual visits. Overall, the post-mandate time period was associated with a 13 percentage point increase in the probability of using developmental services for all youth in the sample (p<0.01). However, the mandate was not associated with significant changes in any of the outcomes for youth that were covered by its provisions. Considered together, the findings of this study suggest that factors other than the passage of an autism mandate account for changes in developmental service use among Texas children with autism.

Table of Contents

Introduction...1

Literature Review...1

Background on Autism Spectrum Disorders...1

Comorbidity, Increased Utilization and costs...2

State Insurance Mandates...3

Mental Health Mandates...4

Autism Mandates...5

Methodology...6

Data Source...6

Analytic framework...7

Research questions and hypotheses...8

Variables...10

Dependent variables...10

Key Independent variables...11

Covariates...12

Statistical methods...13

Descriptive Statistics...13

Main analysis...14

Results...15

Descriptive statistics...15

Main analysis...18

Discussion...21

Trends in Treatment Over Time...21

Underlying differences in service use...22

The role of geography...23

Limitations...24

Internal validity...24

External validity...25

Future directions...26

Conclusions...27

Appendices...28

Appendix A: ICD-9 diagnosis codes used to generate ASD diagnosis and comorbidity indicators...28

Appendix B: Variables and variable values to create visit indicators...29

Appendix C: Full regression results...30

Works Cited...31

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	Spanish
Research Field	Health Sciences, Public Health
Keyword	policy difference in difference insurance costs autism
Committee Chair / Thesis Advisor	Gaydos, Laurie, Emory University
Committee Members	Fehrenbach, Nicole, Centers for Disease Control and Prevention Cummings, Janet, Emory University Von Esenwein, Silke, Emory University
Partnering Agencies	CDC

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