Understanding Racial and Ethnic Disparities in Autism-Related Service Use Among Medicaid-Enrolled Children.
Lucy A Bilaver, Sarah A Sobotka, David S Mandell
PMID 33219917WHAT IT FOUND
Black, Asian, and Native American children with autism received fewer outpatient services than white children, but more school-based services.
This suggests families may be substituting school therapy for medical care, potentially hiding access barriers in the outpatient setting.
Key findings
01Black, Asian, and Native American/Pacific Islander children had significantly lower rates of outpatient autism-related service use compared to white children.
02Black and Asian children had higher rates of school-based service use than white children, despite lower outpatient use.
03Disparities in case management and care coordination were the largest, with Asian children receiving 8.3 percentage points less than white children.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used claims data, which cannot confirm autism diagnoses clinically (87.4% positive predictive value). It cannot distinguish between families choosing school services over outpatient services and those being denied outpatient access. Data quality issues led to the exclusion of several states (Idaho, Colorado, New York, California, Maine), limiting generalizability. The analysis could not account for patient preferences or direct measures of discrimination. Higher functioning children may not qualify for school services, potentially skewing comparisons between groups with different severity profiles.
Declared interests
The authors declare no conflicts of interest. The study used publicly available Medicaid claims data.
The easy way to misread this
Do not assume that higher school-based service use among black and Asian children means they are receiving adequate care. This may reflect a 'substitution effect' where families rely on school therapy because outpatient access is blocked or difficult, potentially leaving broader functional needs in home and community settings unmet.