Is the Autism Boom Headed for Medicaid? Patterns in the Enrollment of Autistic Adults in Wisconsin Medicaid, 2008-2018.
Eric Rubenstein, Lauren Bishop
PMID 31317639WHAT IT FOUND
Most autistic adults in Wisconsin Medicaid were under 30 and entered after 2008.
Adults with autism plus intellectual disability generally had more visits and higher paid amounts than adults with autism alone.
Key findings
01The autism-only group was younger and mostly a recent Medicaid entrant: median age 27 to 28, 72.6% entered after 2008, and 20.3% were enrolled for all eleven years.
02Median visits per year of enrollment were lowest in the autism-only group at 11, while median paid amount was $2,015.8 per year of enrollment.
03Adults with autism plus intellectual disability had more visits than the autism-only group in all age categories except 60 and older, and median paid amount was $9,770.8 per year of enrollment.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study used administrative claims, so it could not describe each person's autism features, intellectual disability severity, or clinical health needs. Race and ethnicity were missing for at least a quarter of beneficiaries in each group, and the data did not include education, income, or location beyond county. The data did not include hospital claims or dual enrollment with Medicare, both of which could change paid amount. The analysis assumed that a year with a claim meant enrollment for the full calendar year, and a year without a claim meant no enrollment, so differences in visits and payments may partly reflect enrollment patterns rather than service use. The study did not test whether adult Medicaid claims accurately identify autism. The data cannot show why enrollment patterns changed, including diagnostic substitution, employer-sponsored insurance, or changing service needs.
Declared interests
The article text does not give a conflicts of interest or funding declaration. The supplied publication types list research support from the NIH, extramural.
The easy way to misread this
Do not treat the low visits and payments in the autism-alone group as proof that these adults need less care. The study describes Medicaid enrollment and claims, not clinical severity, treatment response, or therapy outcomes.