State Approaches to Providing Medicaid Long-term Services and Supports to Children and Youth with Autism Spectrum Disorder

Background:  The Medicaid program is a key source of service funding for children and youth with autism spectrum disorder (ASD) and their families.  Objective:  We surveyed Medicaid and developmental disabilities officials in 50 states and the District of Columbia regarding their state’s use of an autism specific Medicaid 1915(c) waiver to serve children and youth with autism spectrum disorder (ASD), relative to other 1915(c) waiver and state plan options.  Methods:  A survey was developed, based on findings from a pilot key informant study in 5 states with 1915(c) waivers.  State Medicaid officials were emailed an invitation to complete the survey electronically, with additional reminder emails sent to increase response rate.  Findings: Ten of 11 states with a 1915(c) waiver completed a survey providing information on facilitators (e.g., state legislators) and barriers (e.g., provider capacity) to waiver adoption. States with waivers varied greatly in the breadth and depth of their waiver program.  Three states indicated a desire to develop such a waiver, discussing perceived facilitators and barriers to adoption.  Remaining states perceived that children and youth with ASD received adequate services through other 1915(c) waivers (e.g., waiver for individuals with intellectual and developmental disabilities) and/or state plan services (e.g.,  optional rehabilitation benefit).  States varied substantially in the range of services provided to children and youth with ASD and their families.  Implications.  The diversity of state approaches to providing Medicaid services to children and youth with ASD suggests the need to better understand the adequacy of these approaches through additional research.