Disparities in ChildrenHealth Disparities, Coverage Stability and Access to Care Following Autism Insurance Reform

The proposed research addresses HRSA-MCH�s specific area of research interest in improving the quality and effectiveness of health care services and systems with a focus on policies impacting children with autism. The prevalence of autism has grown rapidly in recent decades and affects children from diverse socioeconomic backgrounds. Current insurance reform policies enacted in all 50 states as of 2019 aim to increase access to health care services for children with autism and are targeted toward private insurance for coverage of integrated medical care and behavioral therapies. Published studies have shown that state insurance mandates increased health service utilization among privately insured children with autism. However less is known about the relationship between coverage continuity and access to care following the mandates. Further gaps in health coverage are more likely to impact underserved children from disadvantaged backgrounds which is especially problematic given the intense health care service needs and associated costs and burdens experienced by families of children with autism. This study addresses disparities in health insurance stability among children with autism during the implementation of autism insurance legislation. By leveraging multi-year national datasets the proposed study will 1) investigate the relationship between insurance stability among children with autism and their access to health care and 2) examine state-level variations and explore the impact of insurance gaps on the effectiveness of health care services for children with autism. We will use two national representative datasets the Medical Expenditure Panel Survey sponsored by the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality and the National Survey of Children�s Health sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration to accomplish the specific aims of this proposed study. In order to provide a comprehensive picture of health insurance variations and changes following the mandates multivariable regression models will be used to examine the associations between healthcare access/utilization outcomes and insurance patterns in children with autism differences across various population groups and the impacts of insurance gaps on health access costs and outcomes. These findings will present current evidence on policy change and address the potential health care needs associated with insurance coverage gaps for US children with autism. Federal and state policies and programs need to address the critical issues of coverage stability and optimization of health insurance continuity following the implementation of autism insurance reform.