Brief Report: Healthcare Utilization and Expenditure Trends Among Autistic Transition Age Youth.
Philip H Smith, Jonas Ventimiglia, Joe Wright and 5 others
PMID 41863678WHAT IT FOUND
On Medicaid, autistic youth who also had an intellectual disability used more care and cost far more than those with autism alone, mainly psychiatric outpatient care.
Costs per person rose sharply by adulthood even though fewer used services.
Key findings
01Across nearly every type of care, people with an intellectual disability, with or without autism, used more services and cost more than those with autism alone.
02People with both autism and an intellectual disability had the highest use, most clearly in adulthood: 87.51% used some outpatient care, against 78.43% of the intellectual disability only group and 70.79% of the autism only group, and average spending per person was $40,081.52, against $28,593.49 and $20,003.25. Psychiatric care, not medical care, drove that gap.
03Across the transition to adulthood, fewer people used outpatient and long-term care but spending on each person who did rose substantially, so overall spending per person still increased. Medication use fell on all measures in all three groups.
STILL TO COME
How it was doneWhat they found
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What it does not show
Only fee-for-service and primary care case management claims were studied, because managed care billing data were incomplete for this period. The authors note that most Medicaid enrollees are now in comprehensive managed care, so a large and growing share of care is not represented here. No statistical testing was done. Every comparison in the paper is descriptive, and the authors judged differences by size alone. Because everyone was followed across 2015 to 2019, the analysis cannot separate growing older from changes that affected all Medicaid enrollees over those years, so the same patterns may not hold for young people transitioning now. The claims system changed from MAX to T-MSIS during the study period, which the authors say could affect the comparison between the 2015 and 2019 data. The authors did not test why any of these patterns occurred, and describe their explanations as speculation. Psychiatric and medical care were sorted by billing codes, which the authors say may be misclassified. The study measures billing, not health or daily function. Nothing here shows whether any of the care helped. Only people enrolled at least 10 of 12 months in both 2015 and 2019 could be followed.
Declared interests
The authors state they have no competing interests relevant to the article. The text provided does not say who funded the work.
The easy way to misread this
Do not read the rising spending per person as young people getting more care as they became adults. Fewer used outpatient and long-term care; the increase came from much higher spending on each person who did receive care, and the authors can only speculate why. Nor does this paper show that care got better or worse, because no health outcomes were measured.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →