Whites receive more state funding for autism services than other racial/ethnic groups

Previous evaluations of the state's investment in ASD services have not included adults, a major oversight, according to lead author Paul Leigh, professor of public health sciences and researcher with the Center for Healthcare Policy and Research at UC Davis.

"There are more children diagnosed today with autism than any time in history," Leigh said, referring to data from the U.S. Centers for Disease Control and Prevention estimating that ASD affects 1 in 68 children. "Our findings can help stakeholders, including legislators and health insurance administrators, accurately estimate the costs of autism services and plan their budgets to meet the lifelong need for those services."

ASD is a complex neurodevelopmental disorder present in early childhood that impairs communication, social skills and the ability to understand abstractions. In California, services for people with ASD are funded by the Department of Developmental Services (DDS) through 21 regional centers. Up to age 22, people with developmental disabilities can also receive some support -- such as speech and occupational therapy -- through public schools.

In conducting the study, published in PLOS ONE, Leigh and his team used 2012-13 data on more than 42,000 DDS clients with ASD, including those with the additional diagnosis of intellectual disability.

The researchers found spending differences based on race and ethnicity. Compared to whites aged 3 to 17, average per-person spending was close to $2,000 per person lower for African Americans and Hispanics, with the least spending on African Americans. Differences between whites and other racial/ethnic groups, including Asians, for this age range were small.

Spending differences based on race and ethnicity were more profound for adults with ASD. Compared to whites over the age of 18, average per-person expenditures were nearly $13,000 lower for Hispanics, $8,000 lower for Asians, $6,000 lower for others (including nonresponders, Native Americans and Pacific Islanders) and $4,000 lower for African Americans.

"The reasons for these disparities deserve investigation," Leigh said. "It could be related to the locations of DDS regional offices around the state and the variable costs and availability of services in those areas. But average per-person spending on autism should not differ this much. There are no distinctions in the services needed by people with autism based on race or ethnicity."

There were also spending differences based on age. People age 18 and over receive approximately two and one-half times more funding as younger people with ASD, with the widest gap between the youngest and oldest age groups. Average spending for each DDS client aged 3 to 6 was about $12,000, while average spending on each adult with ASD aged 65 and over was close to $50,000.

"As children with autism grow up and become adults and no longer receive public school-based assistance, their services transition to expensive independent living support and more of the cost burden shifts to the state," Leigh said.

"We hope our data can help justify earlier, expanded and equitable spending on younger children with autism," Leigh added. "There is a great return on investment in high-quality early intervention services, which consistently have been found to reduce the disability associated with autism and to support the greater independence and integration in society as a whole of adults with autism."