Utilization of Medicaid-Funded Speech-Language, Occupational, and Physical Therapies Among Children with Autism Spectrum Disorder during Month of Diagnosis

Background and Purpose: Public funding of treatment for the 1 in 68 children who meet criteria for autism spectrum disorder (ASD) is increasing. Evidence indicates that children with ASD experience disparities in access to diagnosis and health care services. Yet we know little about children’s utilization of Medicaid-funded speech-language (SLT), occupational (OT), and physical (PT) therapies. The purpose of this study was two-fold. First, to examine the probability of utilizing Medicaid-funded SLT, OT, and/or PT during the month of diagnosis, and to determine the relationship between child, family, neighborhood, and geographic characteristics and utilization. Second, to describe the type and setting of therapy children used during the month of diagnosis.

Methods: We integrated data from state agency paper case files, spreadsheets, and electronic records as well as state Medicaid and Census data. The dataset includes children with ASD who enrolled in a Medicaid waiver between its inception (February 2007) and March 31, 2015 (N=2,338). The final study sample included 1968 children. Child variables included sex, age of diagnosis, year of diagnosis (1999-2015), Intellectual Disability, Aspergers Syndrome, and child race (white, black, Hispanic, other non-Hispanic, and unknown). We used means-tested eligibility as a proxy for family income (Supplemental Security Income eligible, TEFRA eligible) and used the residential census tract IDs to determine neighborhood racial composition (percent of white residents), poverty (composite), affluence (composite), and urbanicity (urban, suburban). We assigned state region based on county of residence. Because the majority of children received therapy, we measured developmental therapy utilizationas Yes = 0, No = 1.  We estimated a contextual logistic regression model using PROC LOGISTIC in SAS v9.4.

Results: A total of 1402 children utilized SLT, OT, and/or PT during the month of diagnosis and 566 did not. Compared to children in families with higher income, children in families with lower income had lower odds of not utilizing therapy (odds ratio [OR] 0.43, 95% CI 0.33 to 0.57). For each month increase in age of diagnosis, odds of not utilizing therapy increased (OR 1.01, 95% CI 1.01 to 1.03), and for each year later that children were diagnosed, odds of not utilizing decreased (OR 0.85, 95% CI 0.82 to 0.88). Compared to children in the Midlands region, children in the Lowcountry (OR 1.49, 95% CI 1.12 to 1.98) and Pee Dee regions (OR 1.57, 95% CI 1.10 to 2.24) had increased odds of not utilizing therapy.

Conclusions and Implications: Children with lower income utilize Medicaid to access SLT, OT, and PT, likely due to their eligibility for the means-tested program. As children age, odds of receiving therapy may decrease due to a decline of service availability upon entering school, suggesting a need to enhance access as children age. Results suggest that utilization of therapy has increased since 1999, likely a reflection of recent policy changes to enhance coverage for chidlren with ASD. Variation by state region may reflect provider availability, which offers an opportunity to enhance utilization.