PHILADELPHIA –State mandates requiring commercial health plans to cover the cost of services for children with autism spectrum disorder (ASD) have resulted in an increased number of children being diagnosed and treated for ASD, according to new research from the Perelman School of Medicine at the University of Pennsylvania. The findings will be published in the July 11th issue of JAMA Pediatrics.
David Mandell, ScD
ASD is characterized by impairments in social communication and repetitive behaviors. Its incidence has risen from one in 150 children in 2004 to one in 68 children in 2010. Treatment can require up to 25 hours per week of educational and behavioral interventions for several years. Until recently, the high costs associated with care for children with ASD were not covered by most commercial insurance plans.
In 2001, Indiana became the first state to mandate that behavioral treatments for ASD be covered through commercial health insurance benefits; many other states followed suit starting in 2008. Currently, 44 states have implemented an autism mandate with the idea that it would remove the financial barrier to families that had prevented many children from being diagnosed and treated for ASD.
But, is it working?
A team from Penn’s department of Psychiatry, led by David Mandell, ScD, a professor and director of the Center for Mental Health Policy and Services Research, are the first to embark on research to find out.
Mandell and colleagues examined inpatient and outpatient health insurance claims for children 21 years and younger covered by three of the largest insurers in the U.S. – United HealthCare, Aetna and Humana – from January 2008 through December 2012.
During the study period, 154,089 of the 1,046,850 children in the sample were diagnosed with ASD. In states with ASD insurance mandates, the adjusted prevalence of children diagnosed with ASD was 1.8 per 1,000, compared with 1.6 per 1,000 children in states without a mandate. Overall, the mandates resulted in a 12.7 percent adjusted increase in prevalence of children diagnosed with ASD.
In addition, the researchers noted that the effects of the mandates increased the longer they remained in effect. In the first year of implementation, mandates were associated with a 10.4 percent increase in the proportion of children diagnosed with ASD; in the second year of implementation, this percentage rose to 17.1 and then to 18 percent in later years.
“These are encouraging findings,” Mandell said. “We now know that more children are being served, but we are also acutely aware that these numbers are well below the prevalence of ASD in our society, indicating that the mandates have not had the full effect that advocates desired,” he explained. “This is merely a step in the right direction. These mandates represent a patch, not a panacea.”
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $9.9 billion enterprise.
The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $546 million awarded in the 2021 fiscal year.
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