Effects of Medicaid Waivers for Autism Spectrum Disorder on State Medicaid Expenditures

Background: In the United States, Medicaid is the largest source of funding for healthcare services for individuals with autism spectrum disorder (ASD). Several states have passed Medicaid Home and Community-based Services (HCBS) waivers that expand eligibility criteria and available services for children with ASD. Previous research has shown considerable variation in these waivers, but little is known about their effects on Medicaid expenditures.

Objectives: To estimate the impact of state Medicaid waiver programs targeting children with ASD on state Medicaid expenditures, both for institutional and community-based care.

Methods: We use Medicaid claims data from 2001-2013 to estimate state-level expenditures. A fixed effects model will be used to estimate the effects of specific waiver characteristics on Medicaid expenditures among states and over time. We hypothesize that the waivers will result in substitution from institutional care to community-based care and associated cost savings for the states. The effects of waivers on expenditures for children with ASD will be compared with their effects on children without ASD as way to isolate the effects of waiver characteristics from states’ overall Medicaid generosity.

Results: Analyses are ongoing.

Conclusions: The results will identify waiver characteristics that are associated with cost containment and increased use of community care. These results will be the first step towards helping states develop efficient and effective waivers to support children with ASD and their families.