# Medicaid Expansion and Medication Use Among U.S. Children with ASD or ADHD: A Repeated Cross-Sectional Analysis Comparing Before and During the COVID-19 Periods

## TL;DR

Medicaid expansion was linked to lower medication use among children with ASD or ADHD, but had less impact on those with both conditions during the pandemic.

## Contribution

This study is the first to examine how Medicaid expansion and the pandemic jointly affect medication use in children with ASD or ADHD.

## Key findings

- Medicaid expansion was associated with lower odds of medication use in the full sample but not in the comorbid group.
- The pandemic did not significantly change medication use in either the full sample or the comorbid subgroup.
- Medicaid expansion showed a buffering effect on pandemic-related disruptions in medication use for children with ASD or ADHD.

## Abstract

Background/Objectives: Children with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) frequently rely on pharmacological treatment to manage core symptoms. This study examined how Medicaid expansion and the COVID-19 pandemic influenced medication use among children with ASD or ADHD, including those with comorbid diagnoses. Methods: We analyzed 2016–2023 data from the National Survey of Children’s Health (NSCH) for children aged 3–17 years with caregiver-reported diagnoses. Logistic regression models assessed the association between Medicaid expansion, the pandemic period, and current medication use, including an interaction between expansion and pandemic period. Analyses were conducted for the full sample (N = 35,198) and a subgroup with comorbid ASD and ADHD (N = 4298). Results: Current Medicaid expansion was associated with significantly lower odds of medication use in the full sample (aOR = 0.68, p < 0.001) but not the comorbid group (aOR = 0.98, p = 0.9). Medication use showed no significant change during the COVID-19 period in either the full sample (aOR = 0.99; p > 0.90) or the comorbid subgroup (aOR = 1.22; p = 0.4). A significant interaction indicating increased odds of medication use during the pandemic in expansion states was observed only in the full sample, although a similar but non-significant pattern appeared in the comorbid group. Age, race, and insurance-related differences were significant across groups, with coverage consistency playing a larger role in the full sample. Sensitivity analyses, excluding the 2020 survey year and modeling pre/post pandemic periods, supported the robustness of findings. Conclusions: Medicaid expansion was associated with patterns consistent with buffering pandemic-related disruptions in medication use among children with ASD or ADHD overall, but those with co-occurring conditions remain especially vulnerable.