Association for Public Policy Analysis & Management

Social programs and mandates are usually studied in isolation though they often interact closely with each other. Given the immense recent changes to health insurance systems, there is potential for spillover effects to other systems where health plays a large role. We examine how health insurance interacts with the education of students with disabilities by examining how a mandate for health insurers to cover therapy for Autism Spectrum Disorder (ASD) up to age 18 affects educational services received by and test scores of students with ASD. A key aspect of the mandate is that children covered by Medicaid aged out of benefits quickly (by age 6), leaving them with a far weaker benefit than provided by private insurers. Since we do not observe insurance status, we proxy for private insurance coverage using ineligibility for free/reduced-price lunch (FRPL) and estimate impacts on identification with ASD, special education services, and achievement using difference-in-differences and triple difference models. We find little evidence of an overall shift in ASD identification, though there is some indication of delayed identification. There is also substantial crowd-out of special education services for students with ASD from the mandate. The stronger mandate led to increased mainstreaming of students in general education classrooms and a reduction in teacher consultant support. Girls in particular are more likely to be mainstreamed. There is little evidence of changes in achievement, which supports our interpretation of the service reductions as crowd-out.