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PONE-D-21-01256

Racial and ethnic disparities in benefits eligibility and spending among adults on the autism spectrum: A cohort study using the Medicare Medicaid Linked Enrollee Data Source

PLOS ONE

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PLOS ONE

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: The study described a significant racial and ethnic disparities of Medicare and Medicaid benefits eligibility among adult autism spectrum disorder (ASD). The findings also show that the total medical cost of patients with ASD existed racial and ethnic disparities.

The study limitations have been well thought of and it will be good to investigate the racial and ethnic disparities further in a population cohort that is covered by other healthcare insurances. This study will provide additional resources for further understanding and evaluation of the influence of the health outcomes from such disparities of patients with ASD for the health care policymakers.

Questions/concerns:

1) In the Methods, the authors report only 2012 MMLEADS V2 data was used for the study. Why the authors did not use more recently years, such as 2016, 2017? And is there more background information about this data?

2) Did all participants were continually enrolled in Medicaid, Medicare, or dually all year?

3) Did authors consider those participants with Medicare Part C?

4) In data analysis, the author mentioned that several states (Alaska, Colorado, Hawaii, etc.) were excluded in all models because of large standard errors. I think the potential reason might because of racial and ethnic disparities of ASD diagnosis in different states. (see this article: https://stacks.cdc.gov/view/cdc/22182). Therefore, the authors may include all states and categorize them into “Northeast, South, Midwest, and west”.

5) Living in urban or rural areas also should be considered.

6) Medical conditions should be considered as an important covariate in logistic regression model.

7) Was the cost overall cost? I think the authors should add a short paragraph in the method part to carefully describe how to calculate the cost. In addition, if it is possible based on the data available, the authors may specifically analyze for different types of the cost, such as ASD direct or indirect cost, Emergency department cost, hospitalization cost, ect., and see if it has any racial and ethnic disparities.

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Reviewer #1: No

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Racial and ethnic disparities in benefits eligibility and spending among adults on the autism spectrum: A cohort study using the Medicare Medicaid Linked Enrollee Data Source

PONE-D-21-01256R1

Dear Dr. Benevides,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Kevin Lu, PhD

Academic Editor

PLOS ONE