The interplay of outpatient services and psychiatric hospitalization among Medicaid-enrolled children with autism spectrum disorders.

Objective: To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs).

Design: Retrospective cohort study using discrete-time logistic regression to examine the association of service use in the preceding 60 days with the risk of hospitalization.

Setting: The Medicaid-reimbursed health care system in the continental United States.

Participants: Medicaid-enrolled children with an ASD diagnosis in 2004 (N = 28 428).

Main Exposures: Use of respite care and therapeutic services, based on procedure codes.

Main Outcome Measures: Hospitalizations associated with a diagnosis of ASD (International Classification of Diseases, 10th Revision, codes 299.0, 299.8, and 299.9).

Results: Each $1000 increase in spending on respite care during the preceding 60 days resulted in an 8% decrease in the odds of hospitalization in adjusted analysis. Use of therapeutic services was not associated with reduced risk of hospitalization.

Conclusions: Respite care is not universally available through Medicaid. It may represent a critical type of service for supporting families in addressing challenging child behaviors. States should increase the availability of respite care for Medicaid-enrolled children with ASDs. The lack of association between therapeutic services and hospitalization raises concerns regarding the effectiveness of these services.