There is a considerable and growing population of adults with autism enrolled in Medicaid, a finding that mirrors rising autism rates in children — new findings that have implications for the Medicaid system.
METHODOLOGY:
Longitudinal cohort of adults 18 years and older enrolled in Medicaid between January 1, 2011, and December 31, 2019, with a claim for autism and a roughly 1% random sample of all adult Medicaid enrollees.
The prevalence of autism per 1000 Medicaid enrollees was calculated for each year.
The prevalence by race/ethnicity was calculated for study year 2019.
TAKEAWAY:
A total of 403,028 adults had a Medicaid claim for autism at any point during the 9-year study period (74% male, 74% White, 17% Black, 12% Hispanic, 3% Asian, < 1% Native American, Pacific Islander, and 4% multiple races).
Overall autism prevalence (per 1000) rose from 4.2 in 2011 to 9.5 in 2019.
The increase in prevalence over the study period was largest in adults 25 to 34 years (195%) and smallest in those 55 to 64 years (45%).
The prevalence was highest in White Medicaid enrollees and was nearly two times that of the prevalence in all other racial groups in all age categories.
In 2019, 46% of enrollees with autism claims had claims for intellectual disability (ID), down from 62% in 2011, a finding in line with the decreasing co-occurrence of ID over time, highlighting improved diagnostic approaches and awareness of autism without ID.
IN PRACTICE:
“The study findings suggest that despite difficulties in identifying autism in adults, there is a considerable and growing population of autistic adults enrolled in Medicaid. As children on the autism spectrum become autistic adults, Medicaid is an important insurance provider for an increasing number of autistic adults and can be a valuable resource for understanding the health of the autistic population,” the authors write.
SOURCE:
The study, with first author Eric Rubenstein, PhD, from Boston University School of Public Health, Boston, Massachusetts, was published online October 4 in JAMA Psychiatry.
LIMITATIONS:
The study relied on ICD codes for autism. The prevalence estimates are based on adults identified with autism and served using Medicaid funds, which may miss undiagnosed adults or those without claims.
DISCLOSURES:
The study was funded by a grant from the National Institute on Aging. The authors report no relevant financial relationships.
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