title: Home- and community-based waivers for children with autism: effects on service use and costs.
abstract: We examined (a) the associations between Medicaid home and community-based waiver participation and service use and expenditures among children with ASD; and (b) how states' waiver spending moderates these effects. We used 2005 Medicaid claims to identify a sample of children with autism spectrum disorder (ASD). We selected two comparison groups who had no waiver participation: (a) children who were eligible for Medicaid through disability (disability group), and (b) children who had at least one inpatient/long-term care (IP/LT) episode (IP/LT group). Waiver participants were less likely to use IP/LT services and had lower associated expenditures than the disability group. As states' waiver spending increased, waiver participants became increasingly less likely to use IP/LT services. Waiver participants had more outpatient visits and associated expenditures; this difference increased as state waiver spending increased. Compared with the IP/LT group, waiver participants had lower IP/LT expenditures, more outpatient visits, and associated expenditures. Higher state waiver generosity increased this effect on outpatient visits and expenditures.
authors: Zuleyha
authors: Z
authors: Cidav
authors: Steven C
authors: SC
authors: Marcus
authors: David S
authors: DS
authors: Mandell
mesh_terms: D000293:Adolescent; D001321:Autistic Disorder / Q000191:economics*; D002648:Child; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics*; D014481:United States
keywords: Autism spectrum disorder; Medicaid; home- and community-based waivers; inpatient/long-term care; outpatient care