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Understanding Racial and Ethnic Disparities in Autism-Related Service Use Among Medicaid-Enrolled Children

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.

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Acknowledgments

The authors acknowledge funding from the Health Resources and Services Administration (R40MC288550100) and would like to thank Dr. Benjamin Lê Cook for his methodological guidance.

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LB conceived of the study, participated in its design, performed the statistical analysis, and drafted the manuscript; SS participated in the interpretation of the data and helped to draft the manuscript; DM participated in the design of the study, interpretation of the data, and helped to draft the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lucy A. Bilaver.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This project was determined to be exempt by the institutional review board at Northwestern University.

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Bilaver, L.A., Sobotka, S.A. & Mandell, D.S. Understanding Racial and Ethnic Disparities in Autism-Related Service Use Among Medicaid-Enrolled Children. J Autism Dev Disord 51, 3341–3355 (2021). https://doi.org/10.1007/s10803-020-04797-6

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Keywords

  • Autism spectrum disorder
  • Racial and ethnic disparities
  • Medicaid
  • School-based services
  • Outpatient services