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Friday, October 22, 2010

Autism, the Health Bill, and Medicaid

Bloomberg Business Week reports:

The health law passed in March requires that insurers led by UnitedHealth Group Inc. and WellPoint Inc. begin covering a package of “essential benefits” in 2014. The law doesn’t say what care should be included, leaving that up to the U.S. Department of Health and Human Services. That, in turn, has spurred a lobbying push by advocacy groups for chiropractic care, autism treatments and dozens of therapies.


Coverage is still to be determined on “behavioral health” services, which are a concern for people with autism and their families, said Stuart Spielman, senior policy adviser and counsel for the advocacy group Autism Speaks in Washington.

Insurance coverage for autism services vary from state to state, with people with the condition often getting “very poor care,” he said by telephone. Spielman’s 16-year-old son has autism.

Medical costs for people with autism are four to six times greater than for those without the condition, the Atlanta-based CDC estimates. Twenty-three states have adopted laws requiring insurers to cover screenings, therapy and related services, according to Autism Speaks.

Lifetime treatment for autism costs about $306,000, Michael Ganz of the Harvard University School of Public Health estimated in a 2007 report that didn’t distinguish between severe or mild forms.

Autism advocates are lobbying the government to interpret language in the law requiring coverage of “behavioral health” services to include autism treatment.

The Science Blog reports:

Autism was described as early as 1940 [sic: 1943], but a marked increase in the prevalence for the broader class of autism spectrum disorders (ASDs) during the past decade highlights the demand for treatment of affected individuals. The Centers for Disease Control and Prevention (CDC) reported that the prevalence of ASD was one in 110 children in 2006 and increased at an average annual rate of 57% between 2002 and 2006.1 The rising prevalence has heightened concern about the financial impact of treating ASDs in the private and public health care systems.[1]

The escalating health care expenditures associated with autism spectrum disorders (ASDs) in state Medicaid programs is the subject of a study by Penn State College of Medicine researchers in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).[2]

In the article titled "Health Care Expenditures for Children with Autism Spectrum Disorders in Medicaid," Drs. Li Wang and Douglas Leslie used Medicaid data from 42 states from 2000 to 2003, to evaluate costs for patients aged 17 years and under who were continuously enrolled in fee-for-service Medicaid. Total expenditures included Medicaid reimbursements from inpatient, outpatient, and long-term care, as well as prescription drugs, for each treated patient.

During the study period over two million children were diagnosed with some type of mental disorder. Of these children, nearly 70,000 had an ASD, with approximately 50,000 having autism. Researchers found that total health care expenditures per child with ASD were $22,079 in 2000 (in 2003 US dollars), and rose by 3.1% to $22,772 in 2003.

Strikingly, the increase in the treated prevalence of autism was higher than in any other mental disorder, rising by 32.2% from 40.6 to 53.6 per 10,000 covered lives. Total health care expenditures for ASDs per 10,000 covered lives grew by 32.8% from $1,270,435 in 2000 (in 2003 dollars) to a remarkable $1,686,938 in 2003.