title: Access to care for children with autism in the context of state Medicaid reimbursement.
abstract: This paper examines the role of state residence and Medicaid reimbursement rates in explaining the relationship between having autism and access to care for children. Three questions are addressed: (1) Is there variation across states in the relationship between having autism and access to care? (2) Does taking account of state residence explain a significant amount of the variation in this relationship? (3) Does accounting for Medicaid reimbursement rates enhance our understanding of this relationship? Data from the 2005 National Survey of Children with Special Health Care Needs were combined with state characteristics to estimate a hierarchical generalized linear model of the association between state residence, Medicaid reimbursement rate and problems accessing care for children with special health care needs with and without autism. Findings indicate there is significant variation between states in the relationship between having autism and problems accessing care, and accounting for state residence explains a significant amount of variation in the model. Medicaid reimbursement rates have an independent effect on access to care for children with autism: when families raising children with autism live in states with higher reimbursement rates, they have lower odds of experiencing problems accessing care. The state context in which families live impacts access to care for children with autism. Moreover, when families live in states with higher Medicaid reimbursement rates, they are less likely to experience problems getting care. The value of this analysis is that it helps identify where to look for strategies to improve access.
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. thomas@schsr.unc.edu
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Thomas
authors.forename: Susan L
authors.initials: SL
authors.lastname: Parish
authors.forename: Roderick A
authors.initials: RA
authors.lastname: Rose
authors.forename: Mona
authors.initials: M
authors.lastname: Kilany
mesh_terms: D001321:Autistic Disorder / Q000191:economics*; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data; D007407:Interviews as Topic; D016015:Logistic Models; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D011203:Poverty; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D035862:Vulnerable Populations / Q000706:statistics & numerical data