Medicaid Waivers Reduced Disenrollment Among Autistic Adolescents

March 22, 2023 - Medicaid waivers that focus on individuals with autism spectrum disorder (ASD) can help reduce disenrollment rates among autistic adolescents, a study published in JAMA Network Open found.

Autistic youths are more likely to disenroll from Medicaid as they enter adulthood than non-autistic people due to eligibility changes and inadequate Medicaid services. States can implement 1915(c) waivers that allow them to provide certain services to specific populations.

Researchers used Medicaid data from 2008 to 2016 from 47 states and Washington, DC, to determine if ASD-specific 1915(c) waivers were associated with a lower risk of Medicaid disenrollment among autistic adolescents.

The study sample included nearly 134,000 people with autism who had 12 or more consecutive months of Medicaid enrollment, at least one inpatient or at least two other claims with an ASD diagnosis code, and were between 14 and 26 years old.

Among the sample, 14,739 had disenrolled from Medicaid and 199,216 were continuously enrolled. Disenrolled individuals (22.5 percent) were more likely to be eligible for Medicaid due to poverty than continuously enrolled individuals (5.3 percent). A lower share of disenrolled individuals (47.4 percent) were eligible due to disability compared to continuously enrolled individuals (75.6 percent).

Around 5 percent of disenrolled individuals and 4.1 percent of continuously enrolled individuals lived in states with ASD-specific waivers.

Through age 21, the annual probability of disenrollment was similar among adolescents in states with an ASD-specific waiver, another waiver, or no waiver. At age 19, disenrollment increased for all individuals, although the probability was more pronounced among those in states with Medicaid waivers.

At age 22, the probability of disenrollment in states without waivers increased significantly to over 13 percent. The disenrollment probability for this population remained high through age 26. Meanwhile, in states with Medicaid waivers, the probability of disenrollment remained stable at around 2 percent for ages 22 through 26.

“These findings are important for state policy, as being insured is associated with fewer unmet health care needs and may reduce inpatient and long-term care services and expenses,” researchers wrote.

“States without waivers available for autistic young adults should consider implementing or extending existing waivers to maintain insurance coverage and subsequently improve health outcomes.”

States can leverage different Medicaid waivers to improve care and coverage for various populations. For example, home- and community-based 1915(c) waivers help support people who need long-term care services and support outside an institutional setting.

Medicaid programs can also use 1115 Medicaid demonstration waivers to approve experimental or pilot projects. States can use these waivers to expand global eligibility, address postpartum Medicaid eligibility, and reduce social determinants of health barriers.