Understanding Racial and Ethnic Disparities in Autism-Related Service Use Among Medicaid-Enrolled Children
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ORIGINAL PAPER
Understanding Racial and Ethnic Disparities in Autism‑Related Service Use Among Medicaid‑Enrolled Children Lucy A. Bilaver1 · Sarah A. Sobotka2 · David S. Mandell3 Accepted: 11 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Racial and ethnic disparities in the use of nine common autism-related services among Medicaid-enrolled children with autism spectrum disorder (ASD) were examined, distinguishing between school and other community-based outpatient settings. Using 2012 Medicaid Analytic Extract data, we identified 117,848 continuously enrolled children with ASD. Several racial and ethnic disparities were found, varying by geography. Black, Asian, and Native American/Pacific Islanders received fewer outpatient services compared with white children, but there was no disparity for Latinx children. Black and Asian children received more school-based services than white children. Disparities in case management/care coordination services were largest and present in each minority group. Geographic variation in receipt of services suggests targets for policy intervention to improve access for minorities with ASD. Keywords Autism spectrum disorder · Racial and ethnic disparities · Medicaid · School-based services · Outpatient services
Introduction Racial and ethnic disparities are known to exist in access to timely diagnostic services for autism spectrum disorder (ASD) (Mandell et al. 2002). Studies have also examined disparities in the use of autism-related health and education services (Bilaver and Havlicek 2019; Liptak et al. 2008; Magaña et al. 2012, 2016; Smith et al. 2020) as well as subspecialty services (Broder-Fingert et al. 2013). Limitations in English language proficiency has been found to relate to Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10803-020-04797-6) contains supplementary material, which is available to authorized users. * Lucy A. Bilaver l‑[email protected] 1
Department of Pediatrics, Northwestern University Feinberg School of Medicine, 633 N St. Clair, 20th floor, Chicago, IL 60611, USA
2
Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61st Street, Suite 207, Chicago, IL 60637, USA
3
Department of Psychiatry, Penn Center for Mental Health, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
barriers to service access for the Latinx population (Zuckerman et al. 2017). However, most studies that examine disparities in autism-related service use do not distinguish between clinical factors that may affect service use, such as disorder severity, versus factors that reflect unequal treatment. Understanding the source of differences is an important step towards implementing practice or policy solutions to mitigate racial and ethnic inequities. The Medicaid program is the single largest payer for autism-related health care services. In a
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