title: County-level variation in the prevalence of medicaid-enrolled children with autism spectrum disorders.
abstract: This study examined how county-level resources are associated with the identification of children with autism spectrum disorders (ASD) in Medicaid. Medicaid claims from 2004 were combined with county-level data. There were 61,891 children diagnosed with ASD in the Medicaid system in 2004. Counties with lower per-student education expenditures, more students, a greater proportion of students in special education, higher per capita number of pediatricians and pediatric specialists, and a greater proportion of Medicaid enrollees and white residents had higher Medicaid prevalence. Within states, counties differ in how they implement Medicaid policies. The results suggest the substitution of education and Medicaid-reimbursed services. Our findings highlight the need for geographically targeted outreach to minority groups and clinicians to improve recognition of ASD.
authors.affiliation: Department of Psychiatry, University of Pennsylvania School of Medicine's Center for Mental Health Policy and Services Research, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA. mandelld@mail.med.upenn.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Mandell
authors.forename: Knashawn H
authors.initials: KH
authors.lastname: Morales
authors.forename: Ming
authors.initials: M
authors.lastname: Xie
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
authors.forename: Aubyn
authors.initials: A
authors.lastname: Stahmer
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000191:economics* / Q000453:epidemiology*; D002675:Child, Preschool; D016208:Databases, Factual; D005843:Geography; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008484:Medicaid / Q000191:economics*; D057766:Policy; D015995:Prevalence; D014481:United States; D055815:Young Adult