Socioecological factors captured in autism service disparities research on Medicaid-enrolled patients: a rapid evidence review

There continue to be disparities in access to quality services that vary from the individual to the policy level. Medicaid is particularly relevant to accessing autism services, since obtaining a diagnosis often confers eligibility, regardless of income requirements, making it a major insurer in this population. Therefore, studies using Medicaid claims data to examine autism service access and utilization may provide unique insights into the demographics being studied and the factors influencing service equity. This rapid evidence review followed the Cochrane Rapid Review Methods Group recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to conduct a literature search across five databases (i.e., ERIC, SCOPUS, PubMed, CINAHL Plus, PsycINFO) to locate articles describing studies of autism services utilization conducted in the United States using Medicaid claims data. Studies had to use Medicaid claims, include an autistic population, be peer-reviewed, original empirical research, and examine variances or disparities in autism services. Case studies or series were excluded. Inclusion criteria were assessed using the Covidence review management tool; 60 articles met all criteria and were included. Information was extracted regarding each study, including characteristics of the study and the included participants, including factors analyzed for variation in service utilization. Results show that existing autism disparities research primarily represents the experiences of school-aged children and young adults (ages 6-21 years), pharmacological and therapeutic services, and individual-level factors, limiting the generalizability of existing research on autism service use.