Federal Education Programs that Serve Young Children with Autism

Children with disabilities—including children with autism—can receive  intervention services through IDEA, which is overseen at the federal level  by Education. The limited  coordination was particularly concerning given that we also found that 84  percent of the autism research projects funded by federal agencies from  fiscal years 2008 through 2012 had the potential to be duplicative,  because the projects were categorized to the same research objectives in  the IACC strategic plan. Agencies Used a Variety of Mechanisms to Encourage Early Identification and Interventions

Agencies specifically solicited research on early autism identification and  interventions, and funded research in this area as a result of these  solicitations. Agencies Solicited and Funded Research on Early Autism Identification and Interventions

Through FOAs, four agencies—DOD, Education, NIH, and the Health  Resources and Services Administration (HRSA), another HHS agency— solicited research proposals on early screening, diagnosis, and  interventions for young children with autism from fiscal years 2012  through 2015. State and Federal Education and Health Care Programs Provide a Variety of Intervention Services to Young Children with Autism

Individualized intervention services are provided to young children with  autism through IDEA early intervention and special education programs;  additionally, the five states we examined and DOD have taken specific  actions to help respond to the needs of children with autism that they  serve. Children enrolled in federal health care programs— Medicaid, CHIP, or TRICARE—received a variety of intervention services  through these programs. Young Children with Autism Enrolled in Selected States’ Medicaid or CHIP Programs, or TRICARE Received a Variety of Intervention Services

			Medicaid and CHIP

Children enrolled in Medicaid or CHIP from our five selected states— Delaware, Georgia, Illinois, Kentucky, and Minnesota—received a variety  of intervention services during fiscal year 2013. When services received are examined by age group, speech, language,  and audiology services remain the most commonly received services;  however, there is variation in the other categories of services received. HHS has recently taken actions required by the Autism CARES Act that  could help coordinate federal autism research and implement our  recommendations. First, as directed by the act, the Secretary of Health  and Human Services designated an official to serve as the Autism  Coordinator to oversee national autism research, services, and support  activities and ensure that autism activities funded by HHS and other  federal agencies are not unnecessarily duplicative. These data were made available in April 2016, while a draft of this report  was at the department for comment. While we are not making additional recommendations, we  believe that our 2013 recommendations remain valid, and that HHS’s  continued fulfillment of the provisions in the Autism CARES Act could  help the department implement our recommendations. In their  comments on this report, Education and HHS disagreed that there was  potential for duplication and questioned the basis of our analysis. We  continue to believe that these methods are limited. At  the time we began our review, these were the most recent fiscal years for  which CMS’s and DOD’s data were available. We chose these  five states based on the availability and reliability of their reported  Medicaid and State Children’s Health Insurance Program (CHIP) data in  MSIS. Appendix III: Selected Federal Health Expenditures for Intervention Services Provided to Children with Autism

We examined certain expenditures for the provision of intervention  services to children ages 1 through 5 identified with autism and enrolled  in the Centers for Medicare & Medicaid Services’ Medicaid program, the  State Children’s Health Insurance Program (CHIP), and the Department  of Defense’s (DOD) TRICARE program. Federal Autism Activities: Better Data and More Coordination Needed to  Help Avoid the Potential for Unnecessary Duplication.
Why GAO Did This Study

Research has shown that early intervention can greatly improve the development of a child with autism. Children with disabilities—including children with autism—can receive intervention services through the Individuals with Disabilities Education Act. Low income children may also receive intervention services through Medicaid or CHIP, health care programs overseen at the federal level by the Centers for Medicare & Medicaid Services and administered by the states. Children of servicemembers may receive services through TRICARE, DOD's health care program.
GAO was asked to review federal autism efforts. This report describes (1) how federal agencies encourage early autism identification and interventions, and (2) the intervention services provided by federal education and health care programs. It also (3) examines steps taken by HHS and federal agencies to improve research coordination. GAO collected information on education programs in five states that were selected for size, activities, and variation in geographic location. GAO analyzed health care program data: fiscal year 2014 TRICARE data and fiscal year 2013 Medicaid and CHIP data—the most recent data available at the time of the review—from another five states selected based on the availability of reliable data. GAO also monitored the implementation of its 2013 recommendations to improve autism research coordination. Education and HHS provided comments on a draft of this report and disagreed that there is potential for unnecessary duplication. GAO continues to believe improved coordination is needed.

What GAO Found

Federal agencies have taken various actions to encourage early autism identification and interventions, such as specifically soliciting research in these areas. From fiscal year 2012 through fiscal year 2015, the departments of Defense (DOD), Education, and Health and Human Services (HHS), awarded about $395 million for research on early identification and interventions for autism.
Federal programs provide a variety of intervention services to young children with autism. When examining the education programs administered by five states and DOD, GAO found that specific actions were taken to help respond to the individual intervention needs of children with autism. Children enrolled in federal health care programs—Medicaid, the State Children's Health Insurance Program (CHIP), or TRICARE—received a variety of interventions. For example, GAO identified about 8,200 young children with autism in five states enrolled in Medicaid or CHIP and found that speech, language, and audiology services were the most common overall; however, the types of services commonly received varied, depending on the age of the child.
HHS has recently taken actions required by the Autism Collaboration, Accountability, Research, Education, and Support Act of 2014 (Autism CARES Act) that could help coordinate federal autism research and implement GAO's prior recommendations. For example, in April 2016, HHS designated an autism coordinator to oversee national autism research, services, and support activities. In 2013, GAO reported that there was limited coordination among agencies. This was especially concerning because GAO also found that 11 federal agencies funded autism research in the same areas—resulting in the potential for unnecessary duplication. At that time, GAO recommended that HHS improve the data it collects on autism research and that federal agencies develop methods to monitor and coordinate this research. GAO believes that HHS's continued fulfillment of certain provisions in the Autism CARES Act could help the department implement GAO's 2013 recommendations.