Changes in healthcare expenditures after the autism insurance mandate

Background: In recent years, most U.S. states have passed autism mandates requiring private insurers to cover autism spectrum disorders (ASD). Little is known about the post-mandate changes in healthcare expenditures. Method: This study utilized 2006-2012 de-identified insurance claims data from the largest private insurer in Pennsylvania (PA), where the mandate went into effect in mid 2009. Healthcare expenditures were defined as the amount the insurer paid for healthcare services and were adjusted to 2012 price level. A mixed effects model was used to analyze the expenditures. Results: A total of 9471 children with ASD were included. Although the pre-mandate total expenditures per child with ASD were similar, the post-mandate expenditures significantly increased for groups subject to the autism mandate (87% increase from $7754 in 2008 to $14,486 in 2010) compared to the exempt groups (27% increase from $7238 to $9171). By insurance type, the change from 2008 to 2010 in ASD-related expenditures per child with ASD was $8439 for fully insured large employer sponsored plans and $43 for the Children's Health Insurance Program (CHIP), both subject to the PA mandate; and $2631 for the self-insured, $980 for small employers, and $-92 for individual plans, all of which are exempt from the mandate. These increases were due to outpatient services but not inpatient or drug costs. Conclusions: Healthcare expenditures increased significantly following the PA autism mandate. Nonexempt, large employer groups had the largest increase in spending. Some exempt, self insured companies may have voluntarily covered ASD services, leading to a moderate increase.