Brief Report: Medicaid Expansion and Growth in the Workforce for Autism Spectrum Disorder.
Ryan K McBain, Jonathan H Cantor, Aaron Kofner and 2 others
PMID 34014465WHAT IT FOUND
States expanding Medicaid saw a small increase in board-certified behavior analysts and child psychiatrists, but no change in pediatrician numbers.
This suggests insurance coverage alone does not fix workforce shortages for autism care, particularly for primary providers.
Key findings
01Medicaid expansion was associated with a significant increase in the number of board-certified behavior analysts (BCBAs) per 100,000 children.
02Medicaid expansion was associated with a significant increase in the number of child psychiatrists per 100,000 children.
03Medicaid expansion was not associated with a change in the number of pediatricians per 100,000 children.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study is observational and cannot prove causation; other policies or societal changes occurring at the same time could explain the workforce growth. Data were limited to three provider types (BCBAs, child psychiatrists, pediatricians), excluding other key autism service providers like occupational therapists, speech-language pathologists, and registered behavioral technicians. The analysis did not account for variations in autism prevalence across states, which could influence workforce demand. Provider location and engagement levels were unknown, so the actual availability of care in specific communities may differ from the state-level averages. The study only examined the immediate one-year impact of expansion, so longer-term effects on workforce supply are unknown.
Declared interests
The paper does not report any funding sources or conflicts of interest.
The easy way to misread this
Do not conclude that expanding Medicaid directly causes more therapists or doctors to become available for your patients. The study shows a statistical association at the state level and cannot rule out other factors driving workforce growth.