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Adults on the autism spectrum and those with intellectual disability or mental health conditions may be at increased risk of contracting COVID-19 or experiencing more severe illness if infected. We identified risk factors for COVID-19 among adults enrolled in Medicaid with an autism spectrum disorder diagnosis, intellectual disability, or mental health conditions. We examined adults ages 20–64 years with 9-month continuous enrollment over 2008–2012 using Medicaid Analytic eXtract data. There were 83,150 autistic adults and 615,607 adults with intellectual disability meeting inclusion criteria; of a random sample of 1 million beneficiaries without autism spectrum disorder or intellectual disability, 35.3% had any mental health condition. Beneficiaries on the spectrum, those with intellectual disability, and those with mental health conditions all had higher odds of risk factors for becoming infected with COVID-19 (living in a residential facility, receiving services in the home from outside caregivers, having had a long hospitalization, and having had avoidable hospitalizations) and higher odds of comorbidities associated with severe illness from COVID-19. Clinicians should anticipate high prevalence of comorbidities and risk factors for severe illness from COVID-19 among these populations. Health officials and non-governmental organizations should target these groups with outreach for the COVID-19 vaccine and support continued efforts for appropriate mitigation measures. Lay abstract Autistic adults, adults with intellectual disability, and adults with other mental health conditions may have higher risk of contracting COVID-19 or experiencing more severe illness from COVID-19 if infected. We used data from Medicaid to look at whether autistic adults and other adults with intellectual disability and other mental health conditions were more likely to have risk factors for COVID-19, such as living in a residential facility, receiving services regularly in the home from outside caregivers, having had a long hospitalization, having had avoidable hospitalizations, and having high-risk health conditions. We found that autistic adults had higher odds of living in a residential facility, receiving in-home services from outside caregivers, having had an avoidable hospitalization, and having a high-risk health condition, compared to neurotypical adults without mental health conditions. Adults with intellectual disability had similar odds of having these conditions. Adults with other mental health conditions were also more likely to live in a residential facility, receive services from outside caregivers, and have had avoidable hospitalizations compared to the neurotypical population without mental health conditions. They had three times higher odds of having a high-risk health condition. High risk of COVID-19 among autistic adults and adults with intellectual disability and mental health conditions should be recognized by clinicians, and these groups should be prioritized for vaccine outreach.

Children are at risk of short- and long-term morbidity and mortality from COVID-19. We examine whether autistic children and children with mental health conditions have higher odds of underlying health conditions at high risk of severe disease from COVID-19. We use claims data from a national sample of Medicaid-enrolled children for the years 2008–2016. We examine (1) children with claims for autism and (2) a random sample of children covered by Medicaid, without autism claims but with mental health condition. The comparison group is a random sample of children without autism or any mental health condition. There were 888,487 autistic children, 423,397 with mental health conditions (but not autism or intellectual disability), and 932,625 children without autism or mental health condition. We found 29.5% of autistic children and 25.2% of children with mental health conditions had an underlying condition with high risk for severe illness from COVID, compared to 14.1% of children without these diagnoses. Autistic children had higher odds of having any underlying condition (odds ratio = 2.17; 99% confidence interval = 2.14–2.20), as did children with mental health conditions (odds ratio = 1.71; 99% confidence interval = 1.68–1.73), adjusting for basic demographic characteristics. Children with diagnoses of autism and mental health conditions may be at higher risk for severe COVID due to high-risk condition prevalence. Lay abstract Children are at risk of varying severity of illness and even death from COVID-19. We aim to determine whether autistic children or children with mental health conditions have more underlying health conditions that put people at risk of severe illness from COVID-19. We use data from a national sample of Medicaid-enrolled children for the years 2008–2016. These data include children across the 50 states and the District of Columbia. We compare the prevalence of underlying conditions among autistic children and children with mental health condition to that of other children in Medicaid. This study included 888,487 autistic children, 423,397 with any mental health condition (but not autism), and 932,625 children without any of these diagnoses. We found 29.5% of autistic children and 25.2% of children with mental health conditions had an underlying condition with high risk for severe illness from COVID, compared to 14.1% of children without these diagnoses. Autistic children had over twice the odds of having any underlying conditions, when accounting for age, race, sex, and other characteristics. Children with mental health conditions had 70% higher odds of having these underlying conditions. Mitigation measures in schools and other areas could minimize risk of short- and long-term impacts from COVID for autistic and all children.