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Sunday, July 25, 2021

Medicaid and Autistic Adults

The Politics of Autism includes an extensive discussion of insurance and  Medicaid services for people with intellectual and developmental disabilities.

At Health Services Research,  Lindsay Lawer Shea, Kaitlin H. Koffer Miller, Kate Verstreate, Sha Tao, and David Mandell have an article titled "States' use of Medicaid to Needs of Autistic Individuals."



To assess the use of Medicaid programs, including waivers, to address the needs of aging autistic individuals.

Data sources

We gathered data on Medicaid programs in place between 2004 and 2015 for 50 states and the District of Columbia from the Centers for Medicare and Medicaid Services website, by contacting state Medicaid administrators and advocacy groups, and by reviewing the Medicaid Analytic eXtract Waiver Crosswalk.

Study design

This retrospective analysis classified each Medicaid program and documented state changes over time in eligibility criteria: those serving autism spectrum disorder only, autism spectrum disorder or intellectual disability, and intellectual disability only.

Data collection/extraction methods

We captured age and diagnosis eligibility criteria for Medicaid programs serving any of the three target groups.

Principal findings

A total of 269 Medicaid programs met our criteria and most programs (51%) were 1915(c) waivers. The number of autism-specific 1915(c) waivers grew more than fivefold during the study period, outpacing increases in waivers serving individuals with intellectual disability.


States varied in their use of Medicaid to address the needs of the aging autism population. Further study of characteristics of states that changed their Medicaid programs, and of the health care use and outcomes associated with these changes, are needed to identify opportunities to replicate effective approaches to meeting the needs of this population.

What is already known on this topic

The number of individuals diagnosed with autism spectrum disorder (ASD) is increasing. Most will need services and supports throughout their lives.

Medicaid 1915(c) waivers are a policy mechanism that states frequently use to provide health care insurance to specific populations for targeted services.

What this study adds

States use a variety of Medicaid programs to enroll and serve individuals with ASD; the most common mechanism being the 1915(c) waiver authority.

Twenty-six states changed their 1915(c) waiver programs to increase options for individuals with ASD.

Identifying state policy changes is the first step in comparing outcomes associated with varying approaches.