Autism Spectrum Disorders: Medicaid Spending trends over the Course of Six Years

BACKGROUND: Since Medicaid is known to be the largest payer of children with autism spectrum disorders (ASDs), and since ASDs are on the rise, it is expected that associated costs will also rise with time.

METHODS: The Medicaid Analytic eXtract (MAX) files were used to elicit data for the calendar years 1999 and 2004. All fee-for-service claims for with two or more International Classification of Diseases, Clinical Modification (9th ed.) (ICD-9-cm) diagnosis codes indicating ASD (299.xx) were pulled into working database. Per member per month (PMPM) figures show the average number of claims or expenditures per member per month, adjusted for months of Medicaid enrollment.

BASELINE FINDINGS: Overall, baseline median fee-for-service expenditures for individuals with a disorder on the autism spectrum were $1607 PMPM across nine claims. These figures varied substantially by age with adults living with an ASD having higher health care utilization and costs than children with ASDs. Medicaid expenditures for adults came to a median of $3685 over 13 claims, while children and adolescents up to 21 years of age had median expenditures of $985 over eight claims. This dichotomy clearly reflects some increased health care utilization with age. It also appears that the type of care or prescription drug use necessitated by older individuals with an ASD is more expensive than among younger individuals. Specifically, the median cost per claim is $283 among those 21 and older as compared to $123 per claim for minors. These 1999 Medicaid expenditure findings will be compared to 2004 expenditures.