Health disparities between autistic non-citizen adults and US citizens enrolled in Medicaid: An analysis of Medicaid claims data from 2017-2019

Background

This study addresses critical gaps in our understanding of how immigration status intersects with autism related to health outcomes.

Objective

We aim to quantify physical and mental health disparities between autistic non-citizen adults and US citizens, among those who were enrolled in the Medicaid program.

Methods

We analyzed 2017–2019 Transformed Medicaid Statistical Information System Analytic Files to identify autistic adults and categorize them into US citizens and non-citizens. Using propensity score matching (PSM) based on demographic and eligibility variables, we created comparable groups for comparative analysis of health conditions. We used modified Poisson regression models with robust standard errors to quantify the differences in mental and physical health outcomes between the groups, adjusted for co-occurring intellectual disabilities.

Results

Autistic non-citizens had a 45 % higher prevalence of schizophrenia or other psychotic disorders than autistic citizens, while there were no significant differences in the prevalence of other mental health conditions (e.g., anxiety, depression). Autistic non-citizens also had a higher prevalence of numerous physical conditions (e.g., cancer, diabetes, and kidney disease) than autistic citizens. These patterns were unaffected by adjusting for co-occurring intellectual disabilities.

Conclusion

Our study highlights the heightened vulnerability of Medicaid-enrolled autistic non-citizens compared to their US citizen counterparts. Our findings indicate the critical need for Medicaid policy enhancements to better serve the unique challenges of autistic non-citizen adults, emphasizing the development of practice guidelines that incorporate cross-cultural and immigrant experiences and a culturally and linguistically competent provider base.