Employers seeking to deliver truly comprehensive benefits can no longer afford to overlook autism spectrum disorder (ASD) and its growing impact on their workforce. ASD prevalence has risen sharply. In 2022, approximately one in 31 children eight years of age was diagnosed, compared with one in 150 in 2000, representing a nearly fourfold increase.[1] Yet access to care has not kept pace. There are roughly 82,000 board-certified behavioral analysts nationwide, but many other qualified providers (i.e., Developmental-Behavioral Pediatricians, Child Psychiatrists, and Child Neurologists) remain scarce or out of network for employees and their families.[2]
As diagnoses continue to rise and care gaps widen, employers face escalating utilization and claims costs alongside unmet employee needs. While gaps in care, delays in diagnoses, and oftentimes difficulty in accessing needed care are present within the health insurance industry as a whole, this blog provides foundational context on ASD specifically, and examines where current treatment models fall short, and outlines practical actions that employers can take to manage financial risk while delivering meaningful and sustainable support to employees and their families.
What Is Autism Spectrum Disorder (ASD)?
There is a reason why the condition is called autism spectrum disorder: each individual with ASD experiences the neurodevelopmental disorder (NDD) differently, with a wide variation in the type and severity of symptoms that usually appear in the first two years of life. These symptoms include challenges with social reciprocity, restrictive or repetitive behaviors, and attention regulation, all of which can make daily functioning and social interaction more complex; however, research also indicates that while individuals with ASD may experience greater difficulty communicating with non-autistic individuals, they often demonstrate more effective and comfortable communication when interacting with others on the autism spectrum, reflecting differences in communication styles rather than an absence of social capacity. The disorder can also be accompanied by several potentially costly comorbidities, including anxiety, depression, epilepsy, gastrointestinal and immune function disorders, metabolic disorders, and sleeping disorders.[3]
Autism Treatment Pathways and Employer Cost Pressures
ASD is one of the most complex and rapidly growing care and cost challenges facing employers. Earlier diagnosis and longer treatment durations reflect meaningful clinical progress, but they also reveal significant gaps in how care is delivered, coordinated, and financed.
Treatment for autism is highly individualized and often multidisciplinary, commonly spanning behavioral therapies, such as Applied Behavior Analysis (ABA), speech and occupational therapy, psychiatric services, and an expanding array of home- and community-based supports. For example, every child aged 3-21 in the U.S. who is diagnosed with ASD is entitled to receive, by law, a free appropriate public education (FAPE) designed to meet their unique needs.
This is accomplished through the use of an Individualized Education Program (IEP), which is a legally binding, customized document that outlines specific educational goals, accommodations, and support services tailored to help each child succeed academically and functionally. Increasingly, health systems are attempting to better identify and address the unmet needs of children with medical complexity, many of whom rely on intensive, longitudinal services. In parallel, community-based programs designed to support autistic children and their families continue to grow.
Despite this evolution, autistic children with medical complexity are often managed separately from other medically complex populations in benefit design, service delivery, research, and policy. This siloed approach obscures the substantial overlap between autism and medical complexity and limits visibility into the total cost and intensity of care required for these members.[4]
Cost pressures are further amplified by inconsistencies in provider availability, credentialing standards, and evidence-based oversight. Even when coverage is robust on paper, families frequently encounter long wait times, limited in-network capacity, and geographic disparities that delay intervention. These gaps not only worsen clinical outcomes but also increase downstream costs through crisis services, emergency utilization, and caregiver burnout that impacts workforce productivity and retention.
For employer plans, this fragmentation translates into long treatment horizons, uneven utilization patterns, and significant cost concentration. Autistic individuals with medical complexity, in particular, tend to drive materially higher health care expenditures compared with other populations due to overlapping medical, behavioral, and functional needs.
When access to coordinated, in-network services is constrained, care frequently escalates into out-of-network settings or crisis-driven utilization, further amplifying cost volatility. These dynamics highlight the limitations of traditional utilization management strategies. Visit caps, narrow networks, and isolated prior authorization processes often shift costs rather than improve outcomes, particularly for high-need populations.
How Employers Can Improve Autism Care Strategy
High-performing employer plans are increasingly moving toward more sophisticated strategies: aligning coverage with evidence-based intensity guidelines, investing in early identification and care navigation, and partnering with specialized vendors who can coordinate care longitudinally across medical, behavioral, and community-based services.
At eBen | Risk Strategies Consulting, our team of actuaries, data scientists, nurses, pharmacists, and other specialists are uniquely positioned to help organizations address complex health challenges efficiently and effectively. The goal is not simply reducing spend, but improving predictability, equity, and value. Addressing treatment gaps for autistic children, especially those with medical complexity, requires a population-level understanding of overlapping needs, total cost of care, and measurable outcomes. Employers that invest in integrated, data-driven strategies are better positioned to manage financial risk while delivering meaningful support to employees and their families, strengthening both workforce stability and organizational performance.
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[1] Shaw, K. A. et al. Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years – Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022. MMWR Surveill. Summ. 74, 1–22 (2025).
[3] Al-Beltagi, M. Autism medical comorbidities. World J. Clin. Pediatr. 10, 15–28 (2021).
[4] Piltch, S. Examining ASD Care Challenges: Stuart Piltch’s Perspective. eBen | Risk Strategies https://www.risk-strategies.com/blog/examining-asd-care-challenges-stuart-piltchs-perspective (2023).
