38 - Access to Developmental and Behavioral Services Among Children with Autism Spectrum Disorder Receiving Care at Federally Qualified Health Centers

Publication Number: 3035.38

Felice Liang, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Abraham Gallegos, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Rebecca Hill, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Rebecca Gambatese, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Paul J. Chung, Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, United States; Robert Nocon, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States

Background: Children with autism spectrum disorder (ASD) often require specialized behavioral/developmental (B/D) services, including speech, occupational, and individual therapy. Federally Qualified Health Centers (FQHCs) play a critical role in providing care to publicly insured children, yet disparities in access to ASD-specific services remain poorly understood. Population-level evidence on ASD B/D service access in FQHC settings is limited.

Objective: To examine whether access to B/D services differs between children with ASD who receive ≥50% of their primary care at FQHCs compared with children receiving < 50% of primary care at FQHCs, and to determine whether access varies by service type.

Design/Methods: We conducted a cross-sectional analysis using national Medicaid claims data from 2018, identifying children aged 2-18 years with an ASD diagnosis. Analytic sample was limited to children with ≥1 primary-care visit to define exposure The primary exposure was receiving ≥50% of primary care visits at an FQHC. Outcomes included B/D visit utilization (≥1 visit in the past year) and service-specific utilization (speech, occupational, physical, individual, and group therapy). Multivariable logistic regression estimated adjusted odds ratios (aORs) for B/D visit utilization, adjusting for demographic, geographic, and insurance-related factors. Bivariate analyses assessed utilization differences across specific therapy types by FQHC status.

Results: Children with ASD receiving ≥50% of primary care at FQHCs had lower odds of any behavioral/developmental (B/D) visit (aOR 0.85, 95% CI 0.83-0.86; P<.001). Lower odds were also seen for non-metropolitan residence (aOR 0.85), Children's Health Insurance Program (CHIP) enrollment (0.84), and the Midwest (0.84) and South (0.85) vs Northeast (all P<.001). Odds fell with age, lowest at 15-18y (aOR 0.37; P<.001). In unadjusted comparisons, speech therapy was higher for FQHC-majority (47.1% vs 45.1%; P<.001), while individual (18.9% vs 30.9%) and group therapy (16.2% vs 18.4%) were lower.

Conclusion(s): Children with ASD receiving majority FQHC primary care were less likely to receive any B/D visit overall yet more likely to receive speech therapy. Individual and group therapy were lower, suggesting gaps in access to ASD-specific services. These findings highlight the need to strengthen referral networks and integrate specialized developmental services within FQHCs. Policies aimed at increasing Medicaid reimbursement for ASD-related therapies and expanding provider availability in underserved areas may help address these gaps.

Table 1: Demographics and Service Utilization by FQHC Status
P values from Pearson χ² tests comparing <50% vs ≥50% FQHC primary care

Table 2. Adjusted odds of any behavioral/developmental visit
Adjusted odds ratios from multivariable logistic regression; P values from two-sided Wald tests.

Table 3. Unadjusted therapy utilization by FQHC primary-care continuity
P values from two-sided Pearson χ² tests comparing therapy receipt by exposure group