Self-reported health status is an integral method to understand how adults on the autism spectrum perceive their healthcare and service needs. The objective of the study is to examine how self-reported health changes with use and need of physical health services. The Pennsylvania autism needs assessment included a survey of adults on the autism spectrum responding for themselves. Self-reported health status change over the previous year was reported as improved, decreased, or stable. Adjusted multinomial logistic regression was used to identify characteristics of individuals who experienced decreased or improved health. A total of 1197 adults responded, with most respondents' health remaining stable (68%). Respondents who had a decreased health status reported needing more physical health services (1.64 services) compared to respondents with stable health (1.07 services) and improved health (1.18 services). Respondents with a decreased health status had 1.23 higher odds (95% confidence interval: 1.08-1.40) of having an increase in one physical health service need as compared to those whose health remained stable. Increased physical health service needs were associated with a decreased health status. Adults on the autism spectrum can present with a complex array of needs and determining the role physical health services play in improving and maintaining health remains critical.