Author(s): Jayce Rudd
Mentor(s): Ben Schooley, James Cardon
Institution BYU
Applied Behavior Analysis Therapy (ABA) therapy has recently gained prominence as a therapeutic approach for individuals with autism spectrum disorder (ASD). The treatment of autism has a complex and, at times, controversial history. However, ABA therapy offers an evidence-based alternative by “us[ing] methods derived from scientifically established principles of behavior and incorporates all of the factors identified by the US National Research Council as characteristic of effective interventions in educational and treatment programs for children who have autism.” (Foxx, 2008) Since 2000, all 50 U.S. states have enacted “autism mandates”, which require some degree of insurance coverage for autism-related services. This has resulted in a high amount of variation among states, as shown by Choi, Knight, Stein, and others. (Choi, Knight, Stein 2020) In 2014, the Centers for Medicare and Medicaid Services (CMS) issued guidance on Medicaid's role in covering treatments for autism spectrum disorders in individuals under twenty-one. (CMS, 2014) Although this guidance required states to cover some treatments, it did not mandate Medicaid coverage specifically for ABA therapy. (National Health Law Program, 2014) Consequently, states implemented ABA coverage inconsistently. By February 2022, however, all states had established ABA therapy as a Medicaid benefit, with Texas being the final state to do so. (Autism Speaks, 2022) The gradual implementation of ABA coverage across states over this period created a natural experiment. Previous studies have observed how policy changes impact healthcare access. (Douglas, Benevides, & Caretta, 2017) While previous studies have analyzed the effect of autism mandates on the broader insurance market, they have not specifically focused on ABA coverage implementation in Medicaid programs, nor on how this affects ASD diagnosis rates. In this study, I apply a difference-in-differences approach to examine the effect of increased ABA therapy access on ASD diagnosis rates. Using data from the National Survey of Children’s Health (NSCH) from 2016-2023, which annually samples approximately 95,000 children, I anticipate finding an increase in ASD diagnoses in response to expanded ABA coverage. Quantifying the impact of ABA access on ASD diagnoses can aid healthcare and public health professionals in assessing the community demand for these services.