Treatment for ASD Among Children Lags Despite State Insurance Mandates

Recent research in JAMA Pediatrics found that implementation of state-level mandates requiring commercial health plans to cover services for children with autism spectrum disorder (ASD) increased the amount of children diagnosed with the disorder; however, the proportion of children receiving treatment remained below community prevalence estimates (published online July 11, 2016; doi:10.1001/jamapediatrics.2016.1049).

According to the study, most commercial health insurance companies did not cover treatment for children with ASD, citing the unproven and experimental nature of some treatments as the reason for denying coverage. This led 42 states to pass insurance mandates requiring commercial, fully insured plans to cover ASD screening and behavioral therapies, with treatment cost caps ranging from $12,000 to $55,000 annually. The authors stated that insurance companies fought the mandates on the grounds that the influx of enrollees using ASD-related services would increase dramatically, creating an enormous cost burden. 

To address the question of whether state ASD insurance mandates increased treatment prevalence, David S Mandell, ScD, University of Pennsylvania Perelman School of Medicine, and colleagues conducted a difference-in-differences analysis using insurance claims data for over 1 million children and adolescents younger than 21 years. Insurance data were gathered from United HealthCare, Aetna, and Humana, from between 2008 and 2012, using the Health Care Cost Institute.

When states with mandates and states without mandates were compared, the authors found that that the prevalence of children who utilized ASD treatment was 1.8 per 1000 children in states with insurance mandates, compared with 1.6 per 1000 children in states without mandates (P = .006). The mean increase in treatment usage with implementation of insurance mandates was 0.21 per 1000 children (P < .001).

Although states with insurance mandates in place longer had a higher prevalence of treated children, after 3 years of implementation, the proportion of children being treated for ASD was still lower than community prevalence estimated by the Centers for Disease Control and Prevention. 

The researchers concluded that children covered by private health insurance are underdiagnosed or are being treated through schools and public insurance.—David Costill