Impact of State Mental Health Parity Laws on Access to Autism Services
Abstract
Objectives
Methods
Results
Conclusions
Methods
Data
Study variables
Strict parity law | |||||
---|---|---|---|---|---|
ASD explicitly or implicitly covered | ASD not explicitly or implicitly covered | No strict parity law in effect | |||
State (N=17) | Effective date | State (N=11) | Effective date | State (N=22) | Effective date |
Alabama | 2001 | Colorado | 1998 | Alaskaa | 2009 |
Arkansas | 1997 | Delaware | 1999 | Arizonaa,b | 1998 |
California | 2000 | Hawaii | 1998 | Floridab | 1983 |
Connecticut | 2000 | Idahoc | 2006 | Illinoisb | 2002 |
Georgia | 1998 | Indiana | 1997 | Kansasb | 2002 |
Iowac | 2006 | Marylanda | 1994 | Louisianab | 2000 |
Kentucky | 2000 | New Mexicoa | 2000 | Massachusettsb | 2001 |
Maine | 1996 | Oklahoma | 2000 | Michigana,b | 2000 |
Minnesota | 1995 | South Dakota | 1998 | Mississippib | 1991 |
Missouri | 1999 | Utah | 2001 | Nevadab | 2000 |
Montana | 2000 | West Virginia | 2002 | New York | 2007 |
Nebraska | 1999 | North Carolina | 2008 | ||
New Hampshire | 1995 | North Dakotaa,b | 1985 | ||
New Jersey | 1999 | Ohio | 2007 | ||
Rhode Island | 1995 | Oregon | 2008 | ||
Virginia | 2000 | Pennsylvaniab | 1999 | ||
Vermont | 1998 | South Carolinab | 1997 | ||
Tennesseeb | 2000 | ||||
Texasb | 1997 | ||||
Washington | 2008 | ||||
Wisconsina,b | 1999 | ||||
Wyominga | 2008 |
Statistical analysis
Results
Variable | Full sample (unweighted N=949) | Strict condition-specific (ASD) parity state (unweighted N=342) | Strict non–ASD- specific parity state (unweighted N=194) | Not a strict parity state (unweighted N=413) | pb |
---|---|---|---|---|---|
Independent | |||||
Lives in strict parity state | 45.9 | 100.0 | 100.0 | .0 | <.001 |
Lives in strict condition-specific (ASD) parity state | 34.6 | 100.0 | .0 | .0 | <.001 |
Lives in strict non–ASD-specific parity state | 11.3 | .0 | 100.0 | .0 | <.001 |
Does not live in strict parity state | 54.1 | .0 | .0 | 100.0 | <.001 |
Age (mean±SE years) | 9.8±.2 | 10.0±.4 | 10.2±.4 | 9.7±.3 | .568 |
Male | 82.4 | 88.2 | 78.1 | 79.7 | .042 |
Race-ethnicity | .318 | ||||
Hispanic | 8.8 | 7.4 | 4.8 | 10.5 | |
Nonwhite | 11.1 | 13.6 | 12.4 | 9.2 | |
White | 80.1 | 79.0 | 82.9 | 80.2 | |
Interview not conducted in English | .7 | .0 | 1.5 | .9 | .133 |
1 adult in household | 9.7 | 7.5 | 10.1 | 11.0 | .442 |
Mother has high school education or less | 16.0 | 14.8 | 16.8 | 16.6 | .913 |
% of federal poverty level | .069 | ||||
<50% | .5 | 1.1 | .3 | .1 | |
<100% | 2.0 | .3 | .3 | 3.4 | |
<133% | 4.2 | 1.4 | 4.5 | 5.9 | |
<150% | 2.9 | .7 | 3.7 | 4.2 | |
<185% | 2.7 | 2.4 | 3.3 | 2.7 | |
<200% | 3.8 | 4.1 | 3.4 | 3.8 | |
<300% | 18.4 | 20.2 | 13.1 | 18.3 | |
<400% | 20.1 | 22.0 | 22.8 | 18.4 | |
≥400% | 45.4 | 47.8 | 48.6 | 43.3 | |
Parent-reported severity of child’s health problems | .694 | ||||
Minor | 16.0 | 15.1 | 14.6 | 16.9 | |
Moderate | 63.0 | 60.9 | 64.3 | 64.0 | |
Severe | 19.1 | 21.2 | 20.9 | 17.4 | |
Parent-reported time affected by special health care need | .459 | ||||
Never | 6.1 | 7.5 | 4.7 | 5.5 | |
Sometimes | 37.2 | 38.6 | 37.5 | 36.2 | |
Usually | 17.9 | 13.5 | 25.4 | 19.2 | |
Always | 38.8 | 40.3 | 32.4 | 39.1 | |
Parent-reported stability of special health care need | .149 | ||||
Needs change all of the time | 8.5 | 9.7 | 6.5 | 8.1 | |
Needs change only once in a while | 30.6 | 37.1 | 32.9 | 26.1 | |
Needs are usually stable | 60.9 | 53.3 | 60.6 | 65.8 | |
Parent-reported need for mental health or counseling services in past 12 months | 50.9 | 53.4 | 49.2 | 49.6 | .713 |
Dependent | |||||
Reported spending ≥$1,000 | 46.2 | 45.9 | 47.7 | 46.1 | .961 |
Out-of-pocket spending unreasonable | 52.4 | 56.8 | 47.7 | 50.5 | .374 |
Child’s health care caused financial problems | 37.0 | 37.9 | 42.5 | 35.3 | .610 |
Child’s health care requires additional income | 34.7 | 34.0 | 38.0 | 34.4 | .860 |
Child’s health insurance meets needs | 68.9 | 66.5 | 69.6 | 70.2 | .726 |
Child received mental health service | 81.0 | 78.2 | 69.3 | 85.3 | .334 |
Instrumental | |||||
State’s party power index (mean±SE)c | 1.58±.1 | 1.93±.1 | 1.99±.1 | 1.28±.1 | <.001 |
State’s political ideology index (mean±SE)d | −.11±.0 | −.09±.0 | −.12±.0 | −.12±.0 | .005 |
State’s legislative professionalism score in 1986 (mean±SE)e | .33±.0 | .34±.0 | .18±.0 | .36±.0 | <.001 |
Ordinary least-squares estimate | 2-stage least-squares estimateb | |||||||
---|---|---|---|---|---|---|---|---|
Model 1 | Model 2 | Model 1 | Model 2 | |||||
Outcome | Coefficient | SE | Coefficient | SE | Coefficient | SE | Coefficient | SE |
Out-of-pocket spending >$1,000 | ||||||||
Parity law in effect | −.03 | .03 | −.04 | .05 | −.09 | .10 | −.39** | .13 |
Needed mental health care | .10* | .04 | .09* | .04 | .10* | .04 | −.18† | .11 |
Parity × mental health need | .01 | .08 | .61** | .19 | ||||
Out-of-pocket spending unreasonable | ||||||||
Parity law in effect | .03 | .05 | .04 | .08 | −.07 | .11 | −.07 | .14 |
Needed mental health care | .01 | .06 | .02 | .09 | .01 | .05 | −.08 | .12 |
Parity × mental health need | −.02 | .13 | .18 | .21 | ||||
Child’s health has caused financial problems | ||||||||
Parity law in effect | .02 | .03 | −.02 | .06 | .05 | .09 | .07 | .12 |
Needed mental health care | .09* | .03 | .05 | .05 | .09* | .04 | .08 | .10 |
Parity × mental health need | .08 | .08 | .01 | .18 | ||||
Needed additional income to care for child | ||||||||
Parity law in effect | −.00 | .03 | −.06 | .05 | −.05 | .09 | −.12 | .12 |
Needed mental health care | .12** | .04 | .06 | .06 | .12** | .04 | .03 | .01 |
Parity × mental health need | .12 | .07 | .19 | .18 | ||||
Insurance meets needs | ||||||||
Parity law in effect | −.02 | .05 | −.00 | .06 | .22* | .10 | .33* | .14 |
Needed mental health care | −.02 | .03 | −.00 | .05 | −.01 | .04 | .11 | .10 |
Parity × mental health need | −.03 | .07 | −.27 | .20 | ||||
Received all needed mental health care (unweighted N=469) | ||||||||
Parity law in effect | −.09 | .06 | — | — | −.12 | .15 | — | — |
Ordinary least-squares estimates (unweighted N=949) | 2-stage least-squares estimates (unweighted N=949)b | |||
---|---|---|---|---|
Outcome | Coefficient | SE | Coefficient | SE |
Out-of-pocket spending >$1,000 | ||||
Parity law type (reference: law without condition specificity) | ||||
Parity law in effect with condition specificity | −.02 | .03 | .53 | .47 |
No parity law in effect | .01 | .03 | .35 | .25 |
Needed mental health care | .10* | .04 | .09† | .04 |
Out-of-pocket spending unreasonable | ||||
Parity law type (reference: law without condition specificity) | ||||
Parity law in effect with condition specificity | .09 | .07 | .92* | .44 |
No parity law in effect | .04 | .05 | .51* | .25 |
Needed mental health care | .00 | .06 | −.01 | .05 |
Child’s health has caused financial problems | ||||
Parity law type (reference: law without condition specificity) | ||||
Parity law in effect with condition specificity | −.06 | .04 | −.36 | .46 |
No parity law in effect | −.06† | .04 | −.22 | .24 |
Needed mental health care | .09* | .03 | .09* | .04 |
Needed additional income to care for child | ||||
Parity law type (reference: law without condition specificity) | ||||
Parity law in effect with condition specificity | −.04 | .07 | −.31 | .50 |
No parity law in effect | −.03 | .07 | −.01 | .26 |
Needed mental health care | .12** | .04 | .12** | .04 |
Insurance meets needs | ||||
Parity law type (reference: law without condition specificity) | ||||
Parity law in effect with condition specificity | −.02 | .09 | −.68 | .49 |
No parity law in effect | .00 | .09 | −.54* | .26 |
Needed mental health care | −.02 | .03 | −.01 | .04 |
Received all needed mental health care (unweighted N=469) | ||||
Parity law type (reference: law without condition specificity) | ||||
Parity law in effect with condition specificity | .08 | .08 | −.41 | .67 |
No strict parity law in effect | .16** | .05 | −.10 | .35 |
Discussion
Conclusions
Acknowledgments and disclosures
References
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