Five Key Facts

1. In 2020, nearly 1.6 million autistic people were enrolled in Medicaid services nationwide. Approximately one-third had a co-occurring intellectual disability.
2. About 57% of autistic people qualify for Medicaid based on their disability.
3. More autistic Medicaid enrollees are children versus adults. Over 65% were under the age of 18 years.
4. Autistic people who use Medicaid live in rural areas as well as urban. Nearly 16% live in large or small rural towns.
5. Only about 21% of autistic people, or roughly 332,000 people, have spots in Medicaid Home and Community Based Services (HCBS) waivers in their state, also known as 1915c waivers.

What is a HCBS waiver?

States use Medicaid waivers to pay for specialized home- and community-based services (HCBS) that people with disabilities might need, in addition to covering their health care. Waivers cover services like life skills, nursing, home care, employment supports, and other vital assistance.

What do these facts tell us?

• Autistic people of all ages rely on Medicaid.
• The number of autistic people who use Medicaid is growing. We recently reported that nearly 600,000 autistic people used Medicaid in 2016, compared to 1.6 million in 2020.
• Autistic people who use Medicaid exist across this nation and in your neighborhood, in rural areas and urban.
• More qualify based on their disability, versus those who qualify based on poverty or other reasons. People who qualify based on disability have a significant level of functional impairments, based on federal eligibility rules.
• Cuts to Medicaid will hurt autistic children who rely on Medicaid coverage for diagnostic, therapeutic, and health service coverage. Schools also use Medicaid to pay for special services for autistic children.
• Some autistic people are able to work. But, even when autistic people are able to work, most work part-time at jobs that don’t offer benefits like health care.
  • If autistic people are required to work to keep their Medicaid benefits, this will be especially difficult for them. Many autistic people need support to find and keep a job. Only 1% of autistic people who need employment services get them.
• States use Medicaid waivers to pay for specialized home- and community-based services autistic people might need - like life skills, nursing, home care, employment supports, and other vital assistance. Thousands of autistic people are waiting for a spot in one of their state’s Medicaid waivers. Cuts to Medicaid will make these waits even longer.
  • If states receive less federal funding to support their Medicaid program, they will have to make cuts. People with disabilities who do not have a spot in a Medicaid waiver could be more vulnerable to these cuts.
  • When people don’t have home-and community-based services, family members often cut back on work to provide this care themselves. Loss of coverage for home- and community-based care could also mean that more people will have to be placed in institutional care that is isolating and extremely costly.

How do we know?

Our team analyzed 2020 Medicaid claims data for autistic children and adults. We included people who had at least two outpatient claims, or one inpatient claim, associated with an autism code.

To learn more about how autistic people use Medicaid services, read our Introduction to Medicaid and Autism.