School-Based Behavioral Health Service Use and Expenditures for Children With Autism and Children With Other Disorders.
OBJECTIVE
This study compared use of and associated expenditures for Medicaid-reimbursed school-based and out-of-school services for children with autism spectrum disorder (ASD) and those with other psychiatric disorders.


METHODS
Philadelphia County Medicaid claims were used to identify children ages five to 17 who received behavioral health services through Medicaid any time between October 2008 and September 2009 (N=24,271). Children were categorized into four diagnostic groups: autism spectrum disorder (ASD), conduct disorder or oppositional defiant disorder (conduct-ODD), attention-deficit hyperactivity disorder (ADHD), and other psychiatric disorders. Logistic regression analysis compared use of in-school and out-of-school behavioral health services between children with ASD and children with other psychiatric disorders. Generalized linear models with gamma distribution were used to estimate differences in Medicaid expenditures for in-school and out-of-school services and total Medicaid expenditures for both service types by disorder, with adjustments for age, sex, and race-ethnicity.


RESULTS
The most common diagnosis was ADHD (40%); 35% had other psychiatric disorders, 21% had conduct-ODD, and 4% had ASD. A significantly greater proportion of children with ASD (52%) received in-school behavioral health services (conduct-ODD, 5%; ADHD, 8%; and other psychiatric disorders, 1.7%) Per-child expenditures for both school-based and out-of-school behavioral health services were significantly higher for children with ASD than for children in the other groups.


CONCLUSIONS
Medicaid represents an important source of in-school and out-of-school care for children with ASD and their families. States that expand Medicaid under the Affordable Care Act should give careful consideration to covering school-based mental health services for children with ASD.
Dr. Kang-Yi, Dr. Locke, Dr. Hadley, and Dr. Mandell are with the Department of Psychiatry, Perleman School of Medicine, and Dr. Marcus is with the School of Social Policy and Practice, all at the University of Pennsylvania, Philadelphia (e-mail: ckangyi@upenn.edu ).
Christina D
CD
Kang-Yi
Dr. Kang-Yi, Dr. Locke, Dr. Hadley, and Dr. Mandell are with the Department of Psychiatry, Perleman School of Medicine, and Dr. Marcus is with the School of Social Policy and Practice, all at the University of Pennsylvania, Philadelphia (e-mail: ckangyi@upenn.edu ).
Jill
J
Locke
Dr. Kang-Yi, Dr. Locke, Dr. Hadley, and Dr. Mandell are with the Department of Psychiatry, Perleman School of Medicine, and Dr. Marcus is with the School of Social Policy and Practice, all at the University of Pennsylvania, Philadelphia (e-mail: ckangyi@upenn.edu ).
Steven C
SC
Marcus
Dr. Kang-Yi, Dr. Locke, Dr. Hadley, and Dr. Mandell are with the Department of Psychiatry, Perleman School of Medicine, and Dr. Marcus is with the School of Social Policy and Practice, all at the University of Pennsylvania, Philadelphia (e-mail: ckangyi@upenn.edu ).
Trevor R
TR
Hadley
Dr. Kang-Yi, Dr. Locke, Dr. Hadley, and Dr. Mandell are with the Department of Psychiatry, Perleman School of Medicine, and Dr. Marcus is with the School of Social Policy and Practice, all at the University of Pennsylvania, Philadelphia (e-mail: ckangyi@upenn.edu ).
David S
DS
Mandell
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D000067877:Autism Spectrum Disorder / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D019955:Conduct Disorder / Q000453:epidemiology*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics*; D058991:Patient Protection and Affordable Care Act; D010414:Pennsylvania; D012572:School Health Services / Q000191:economics*; D012574:Schools; D014481:United States