The Effect of an Autism Insurance Mandate on the Education of Children with ASD
AbstractAutism Spectrum Disorder (ASD) is one of the fastest growing developmental disabilities in the US. Recently, a number of states have sought to address spiraling costs of ASD treatment by introducing insurance mandates for Applied Behavioral Analysis (ABA) therapies that have been shown to generate substantial improvement in children's behavior. These mandates have the potential to help schools by shifting cost burdens, increasing early intervention and outside therapy that could improve student performance, and helping schools target and coordinate services.
We assess the effects of Michigan’s coverage mandate on autism identification, test scores, grade retention, test accommodations, support services, and educational settings using individual student level data from the Michigan Department of Education. Michigan adopted its autism insurance mandate in 2012 requiring coverage for ASD by private state regulated insurers up through age 18. The law also required Medicaid and CHIP to provide coverage that ended upon reaching age 6 considerably weakening the benefit. Since we cannot directly observe insurance coverage, we proxy using economic disadvantage. Hence we estimate a dosage intention-to-treat where non-disadvantaged students are more likely to be privately insured and Medicaid/CHIP provides an inferior benefit. Census data for Michigan suggests that only 31% of children income eligible for reduced-price lunch are privately insured as opposed to 89% of ineligible children.
Using a difference-in-differences strategy we find no effect on ASD incidence. We then estimate triple difference models using non-ASD special education students as a comparison group and find evidence of service reductions and movement to less restrictive environments. Finally, triple difference models suggest a negative impact on achievement and higher retention. We will buttress with the data on the number of Board Certified Behavior Analysists (BCBAs) close to students’ schools. BCBAs are the primary providers of ABA therapies, and insurance typically requires BCBA supervision.