Abstract
This paper examines the role of state residence and Medicaid reimbursement rates in explaining the relationship between having autism and access to care for children. Three questions are addressed: (1) Is there variation across states in the relationship between having autism and access to care? (2) Does taking account of state residence explain a significant amount of the variation in this relationship? (3) Does accounting for Medicaid reimbursement rates enhance our understanding of this relationship? Data from the 2005 National Survey of Children with Special Health Care Needs were combined with state characteristics to estimate a hierarchical generalized linear model of the association between state residence, Medicaid reimbursement rate and problems accessing care for children with special health care needs with and without autism. Findings indicate there is significant variation between states in the relationship between having autism and problems accessing care, and accounting for state residence explains a significant amount of variation in the model. Medicaid reimbursement rates have an independent effect on access to care for children with autism: when families raising children with autism live in states with higher reimbursement rates, they have lower odds of experiencing problems accessing care. The state context in which families live impacts access to care for children with autism. Moreover, when families live in states with higher Medicaid reimbursement rates, they are less likely to experience problems getting care. The value of this analysis is that it helps identify where to look for strategies to improve access.
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Kogan, M. D., et al. (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics, 122(6), e1149–e1158.
Sheldrick, R. C., & Perrin, E. C. (2010). Medical home services for children with behavioral health conditions. Journal of Developmental and Behavioral Pediatrics, 31(2), 92–99.
Mandell, D. S., et al. (2009). Racial/ethnic disparities in the identification of children with autism spectrum disorders. American Journal of Public Health, 99(3), 493–498.
Thomas, K. C., et al. (2007). Access to care for autism-related services. Journal of Autism and Developmental Disorders, 37(10), 1902–1912.
Krauss, M. W., et al. (2003). Access to specialty medical care for children with mental retardation, autism, and other special health care needs. Mental Retardation, 41(5), 329–339.
Mandell, D. S., & Palmer, R. (2005). Differences among states in the identification of autistic spectrum disorders. Archives of Pediatrics and Adolescent Medicine, 159(3), 266–269.
Stahmer, A. C., & Mandell, D. S. (2007). State infant/toddler program policies for eligibility and services provision for young children with autism. Administration and Policy in Mental Health, 34(1), 29–37.
Mandell, D. S., et al. (2010). Age of diagnosis among Medicaid-enrolled children with autism, 2001–2004. Psychiatric Services, 61(8), 822–829.
McGuigan, W. M., et al. (2003). Multi-level determinants of retention in a home-visiting child abuse prevention program. Child Abuse and Neglect, 27(4), 363–380.
Miller, D. P. (2011). Associations between the home and school environments and child body mass index. Social Science and Medicine, 72(5), 677–684.
Frank, R., & Bjornstrom, E. (2010). A tale of two cities: Residential context and risky behavior among adolescents in Los Angeles and Chicago. Health and Place, 17, 67–77.
Chilenski, S. M. (2011). From the macro to the micro: A geographic examination of the community context and early adolescent problem behaviors. American Journal of Community Psychology. doi:10.1007/s10464-011-9428-z.
Goldsmith, L. (2002). A Critical history of Andersen’s behavioral model of health services use: A reflection of how we study access to health care. In: Academy for Health Services Research and Health Policy Meeting, p. 6.
Davis, K., & Schoen, C. (1978). Health and the war on poverty: A ten-year appraisal. Washington, DC: Brookings Institution.
Mitchell, J. B. (1991). Physician participation in Medicaid revisited. Medical Care, 29(7), 645–653.
Baker, L., & Beeson, A. (2000). Medicaid policy, physician behavior, and health care for the low-income population. The Journal of Human Resources, 35(3), 480–502.
DeRigne, L., et al. (2009). The influence of health insurance on parent’s reports of children’s unmet mental health needs. Maternal and Child Health Journal, 13(2), 176–186.
Lindley, L. C., & Mark, B. A. (2010). Children with special health care needs: Impact of health care expenditures on family financial burden. Journal of Child and Family Studies, 19(1), 79–89.
Nageswaran, S., et al. (2010). Do children with developmental disabilities and mental health conditions have greater difficulty using health services than children with physical disorders? Maternal and Child Health Journal, 15(5), 634–641.
Parish, S. L., et al. (2009). Financial burden of raising CSHCN: Association with state policy choices. Pediatrics, 124(Suppl 4), S435–S442.
Parish, S. L., et al. State Medicaid spending and financial burden of families raising children with autism. Pediatrics (under review).
Newacheck, P. W., et al. (2009). The future of health insurance for children with special health care needs. Pediatrics, 123(5), e940–e947.
(2010). Patient Protection and Affordable Care Act Pub L. 124 Stat. 119.
Kenney, G., & Pelletier, J. (2010). How will the patient protection and affordable care act of 2010 affect children?. Washington, DC: The Urban Institute.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.
Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208–220.
Blumberg, S. J., et al. (2008). Design and operation of the National Survey of Children with Special Health Care Needs, 2005–2006. Vital and Health Statistics, 1(45), 1–188.
Bethell, C. D., et al. (2002). Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2(1), 38–48.
American Academy of Pediatrics. (2008) AAP Medicaid Reimbursement Survey, 2007/08. In: http://www.aap.org/research/medreimpdf0708/49state_DC.pdf.
Annie E. Casey Foundation. (2009). Median family (with child) income: 2005. In: www.kidscount.org/datacenter/compare_results.jsp?i=340&dt=3&rt=2&yr=6&s=a&rtype=&x=140&y=6.
US Census Bureau Population Division. (2006). Annual estimates of the population for counties: April 1, 2000 to July 1, 2005 (CO-EST2005-01-04). Washington, DC: US Census Bureau.
US Census Bureau Population Division. (2010). Metropolitan and micropolitan statistical areas and components, December 2009, with codes. Washington, DC: US Census Bureau.
Ruble, L. A., et al. (2005). Access and service use by children with autism spectrum disorders in Medicaid managed care. Journal of Autism and Developmental Disorders, 35(1), 3–13.
Croen, L. A., et al. (2006). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics, 118(4), e1203–e1211.
Goin-Kochel, R. P., et al. (2006). How many doctors does it take to make an autism spectrum diagnosis? Autism, 10(5), 439–451.
Chang, C. F. (2007). Evolution of TennCare yields valuable lessons. Managed Care, 16(11), 45–49.
Schafer, J. (1997). Analysis of incomplete multivariate data. Boca Raton, FL: Chapman & Hall/CRC.
Rose, R. A., & Fraser, M. (2008). A simplified framework for using multiple imputation in social work research. Social Work Research, 32(3), 171–178.
Raudenbush, S., & Bryk, A. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks: Sage Publications.
Muthén, B., & Muthén, L. (2004). Mplus user’s guide. Los Angeles, CA: Muthén & Muthén.
Snijders, T., & Bosker, R. (1999). Multilevel analysis: An introduction to basic and advanced multilevel modeling. London: SAGE publications Ltd.
Thomas, K. C., et al. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services, 60(10), 1323–1328.
Washington State Department of Health. (2008). Children with special health care needs program. In: http://www.doh.wa.gov/cfh/mch/autism/StateGrant.htm. Accessed on March 3, 2011.
Berman, S., et al. (2002). Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients. Pediatrics, 110(2 Pt 1), 239–248.
Thomas, C. R., & Holzer, C. E. (2006). The continuing shortage of child and adolescent psychiatrists. Journal of the American Academy of Child and Adolescent Psychiatry, 45(9), 1023–1031.
Chien, A. T., et al. (2010). Improving timely childhood immunizations through pay for performance in Medicaid-managed care. Health Services Research, 45(6 Pt 2), 1934–1947.
Griffin, S. O., et al. (2007). Impact of increasing Medicaid dental reimbursement and implementing school sealant programs on sealant prevalence. Journal of Public Health Management and Practice, 13(2), 202–206.
Abrams, M., et al. (2011). Realizing health reform’s potential: How the Affordable Care Act will strengthen primary care and benefit patients, providers, and payers. Commonwealth Fund, 1, 1–28.
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Support for this study was provided by the Maternal and Child Health Bureau of the Health Resources and Services Administration (R40MC17158).
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Thomas, K.C., Parish, S.L., Rose, R.A. et al. Access to care for children with autism in the context of state Medicaid reimbursement. Matern Child Health J 16, 1636–1644 (2012). https://doi.org/10.1007/s10995-011-0862-1
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DOI: https://doi.org/10.1007/s10995-011-0862-1