CMS shares Medicaid, CHIP data on children with ASD, autism

CMS released a brief exploring the status of children with autism or autism spectrum disorder (ASD) in Medicaid and CHIP.

Since ASD is much more common among children with public payer coverage than those who were uninsured or had private insurance, CMS data on access to care and co-occurring conditions gives important insight into this population.

“ASD is a developmental disability that can cause significant social, communication, and behavioral challenges,” the brief explained. “A diagnosis of ASD includes several conditions: autistic disorder, pervasive developmental disorder not otherwise specified, and Asperger syndrome.”

Around 5% of children between the ages of three and seventeen who are under public coverage have autism or ASD. In contrast, 2% of children with private coverage and 2% of children without coverage were reported as having autism or ASD.

The condition was more prevalent among male children. CMS found that 8% of boys ages three to eleven and 8% of boys ages twelve to seventeen had autism or ASD, compared to 3% and 2% of female children respectively. Also, non-Hispanic White children had higher rates of autism or ASD than other races.

Children with public payer coverage tended to have moderate or severe autism or ASD, as reported by parents. Almost two-thirds of children with autism or ASD (64%) had moderate or severe conditions, while the remaining 36% were reported to have mild symptoms.

Half of all children who had autism or ASD in public coverage were diagnosed early, before the age of four. Another 35% were diagnosed between the ages of four and eight.

“Early diagnosis of Autism or ASD helps individuals with the condition and their families access appropriate services,  and can reduce stress. It can lead to more targeted interventions, better social outcomes, and increased independence in adulthood,” the CMS brief expounded.

Most children with public coverage who had ASD or autism were also managing co-occurring conditions.

 Over two-thirds of the children had a learning disability (68%) or a developmental delay (68%), 62% of children had a speech or language disorder, and 58% displayed behavioral or conduct problems. Other common co-occurring conditions included attention deficit disorder or attention-deficit/hyperactivity disorder, anxiety, allergies, and asthma.

Children who experienced severe or moderate autism or ASD were more likely to receive behavioral healthcare in the last year. Public payer beneficiaries were as likely as private payer members to receive behavioral health support in the same timeframe.

Despite juggling many needs, 60% of parents reported their children’s health status as “excellent” or “very good” and 31% reported their status as “good.”

CMS noted that states have various opportunities to provide coverage for children with autism or ASD in public payer programs. For example, the federal Medicaid program allows access to preventive services and therapy. And the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) ensures that children under Medicaid undergo the proper screenings to catch these conditions early.