The Effect of State Mental Health Parity Laws on Financial Burden and Unmet Needs for Children with Autism Spectrum Disorder

Background:  

State mental health parity laws have been enacted over the last several decades to ensure coverage for mental health treatments.  The laws vary considerably in their provisions as well as the specific health conditions they cover.  Autism spectrum disorder (ASD) is one condition that is not uniformly covered by state mental health parity laws.  Although previous research has looked broadly at the impact of state parity laws on unmet need for mental health services and financial burden, there is no empirical evidence of the effect of state parity laws on these factors for children with ASD.  

Objectives:  

The purpose of this analysis is to study the financial effects and impact on unmet need of state mental health parity laws on children with ASD.  

Methods:

Ordinary least squares regression is used to measure associations in the National Survey of Children with Special Health Care Needs (NS-CSHCN), 2005-2006.  The subpopulation examined in this analysis includes all children aged 3 and older with private health insurance.  Because the passage of state mental health parity laws may be endogenous with the study outcomes, we use state political characteristics as instrumental variables in the same manner as Barry and Busch (2007).  Estimates from the OLS regressions are compared with those from a 2-stage estimation procedure while incorporating survey weights for the subsample.  

Results:  

Thirty-nine percent of the 982 children in the subsample with ASD were living a state that had a parity law that implicitly or explicitly covered ASD.  Ordinary least squares estimates indicate that living in a parity state was associated with some measures of financial burden but not unmet need for mental health services.  For each of the measures of financial burden (out of pocket spending exceeding $1,000, report of needing more money for care, report of financial problems due to special need) children with ASD living in a parity state were more likely to report such burdens compared with children not living in a parity state.  The opposite was true for children without ASD living in a parity state; these children were less likely to report financial burden compared with children who did not live in a parity state.  After accounting for endogeneity in the parity state estimates, we found that the direction of the effects for children with ASD living in parity states changed and increased in magnitude.  In all cases, these children were less likely to report financial burden compared with children not living in parity states although the effects were only statistically significant for children living in ASD parity states.  The type of parity law, however, was not associated with a significant difference among children with ASD.

Conclusions:  

There is some evidence that in terms of financial burden, families of children with ASD benefited from living in states with mental health parity laws that covered ASD.  This analysis adds to the evidence that insurance mandates can affect the financial burden associated with health care costs of children with special needs.  

See more of: Social Risk Factors and Influences On Phenotype
See more of: Epidemiology
See more of: Prevalence, Risk factors & Intervention

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