The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities.
Straiton-Webster, D., & Ingersoll, B. (2025). Short report: Disparities in hours of applied behavior analysis services for Medicaid-enrolled autistic youth. Autism, 0(0). https://doi.org/10.1177/13623613251392495
Abstract
To date, no studies have investigated whether disparities in hours of applied behavior analysis (ABA) exist in the Medicaid system. We used multilevel modeling to analyze Medicaid billing claims for 1,028 autistic youth under the age of 21 years to examine the extent to which there were disparities in hours of ABA services for Medicaid-enrolled youth based on race/ethnicity and rurality. Although younger children received more hours of ABA, F(1, 964.63) = 118.28, p < .001, there were no statistically significant differences in hours of ABA based on minoritized race/ethnicity status or sex. On average, youth served in rural areas received significantly less hours of ABA per month than those in non-rural areas, F(1, 122.13) = 7.89, p = .006; youth in rural areas received 10.86 less hours per month than those in non-rural areas. Results suggest that publicly funded service systems like Medicaid may reduce ABA service disparities by race/ethnicity. Policymakers should focus on improving service provision for youth in rural areas.
From the article:
We found robust evidence of treatment disparities based on rurality; youth served in rural areas received 10.86 hr less of ABA per month compared to those in non-rural areas. Rural areas experience greater geographic barriers, which affect access to both center-based services (e.g., family’s ability to commute to an agency) and home-based services (e.g., provider’s ability to commute to a family's home). Indeed, a recent study found that providers in this system reported difficulty accessing families in rural areas as a significant barrier to the delivery of ABA services (Straiton et al., 2021). These geographic barriers could lead to a higher number of unscheduled or canceled sessions. Furthermore, based on the uneven geographic distribution of autism services, providers in rural areas may need to serve more youth than those in urban and suburban areas (Drahota et al., 2020; Yingling et al., 2022), which limits the number of treatment hours that can be scheduled per child. To improve access to services in rural areas, policymakers and agency leaders should consider targeted recruitment methods and incentive structures for recent graduates to practice in rural locations, provision of flexible supervision models for new graduates, increased use of telehealth service models, and remote consultation services for complex cases (Albright & Williams, 2021; Dew et al., 2013; Mazurek et al., 2017).
