The Association of the Medicaid 1915(c) Home and Community-Based Services Waivers with Emergency Department Utilization among Youth with Autism Spectrum Disorder.
Guodong Liu, Diana L Velott, Lan Kong and 7 others
PMID 33966133WHAT IT FOUND
Youth with autism enrolled in Medicaid home and community waivers had fewer emergency department visits.
ASD waivers were associated with 40% lower annual visits than no waiver; IDD waivers with 30% lower.
Key findings
01Compared with no waiver, enrollment in an ASD waiver was associated with a 40% lower annual incidence of ED visits, and enrollment in an IDD waiver with a 30% lower annual incidence.
02The ASD waiver association was significantly stronger than the IDD waiver association.
03Other waiver types were not significantly associated with ED visits compared with no waiver.
STILL TO COME
How it was doneWhat they found
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What it does not show
This was an observational Medicaid claims study, not a randomized trial, so it cannot show that waiver enrollment caused fewer ED visits. Very little random assignment to waivers occurred, and state waitlist practices may have introduced selection bias. The study used claims data only, so diagnoses, waiver services, and reasons for ED visits were limited and could be misclassified. ASD waiver exposure was very small: average annual enrollment was 0.4%, only 14 states offered it during the study period, and less than 0.5% of the cohort used one. The study could not identify which waiver services, such as behavioral treatment, case management, respite, or personal care, were linked to lower ED use. Race and ethnicity analyses were limited because 17.7% of the sample had unknown race or ethnicity.
The easy way to misread this
Do not conclude that waiver enrollment or any specific therapy caused fewer emergency department visits. The study was observational, ASD waiver use was rare, and the authors could not identify the services or causal pathways behind the association.