Amacandelo okuLawulwa kweeNkcazo kunye neKamva leMedicaid
Xa kuziwa ekunyamekeleni abantwana, iMedicaid ichaza oko kuthatha ukubenza baphile. Ngowe-1967, urhulumente wezepolisi wamisela inkqubo ye-Early and Periodic Screening, Diagnostic and Treatment (EPSDT), ngeziphumo ezilandelayo:
- Ukuhlolwa kwesantya kunye nexesha elifanelekileyo : ngamnye Umntwana unokufikelela ekukhuselweni nasekunyamekeleni okwenzeka kwishedyuli ebekiwe. Injongo kukufumanisa iingxaki ekuqaleni ukwenzela ukuba zilungiswe ngokukhawuleza. Iinkonzo zibandakanya kodwa azikhawulelwanga kwinkathalelo yamazinyo, iimvavanyo zokuvavanya , ukugonywa, ukuhombisa ukukhangela , iinkonzo zempilo yengqondo kunye nokuhlolwa kwembono.
- Ukuxilongwa : Kukho naziphi na iimvavanyo zokuhlola eziphambili okanye ezilungileyo, i-EPSDT idinga ukuba iMedicaid igqibe uvavanyo olongezelelweyo ukuqinisekisa ukuxilongwa.
- Unyango : Nakuphi na ukuxilongwa okuqinisekisiweyo, i-EPSDT idinga ukuba urhulumente ahlawule unyango oluyimfuneko, kungakhathaliseki ukuba le ngeniso ayinakuqulathwe ngokuqhelekileyo yiMedicaid.
I-EPSDT yintlawulo enikwe igunya elibeka phambili ukunyamekela nokunyamekela phambili kunye neziko kubantwana. Kuxanduva lombuso ngamnye ukubonelela le ntlawulo kubantwana nakwi-adolescents ababhalise kwinkqubo yeMedicaid baze baneminyaka engama-21 ubudala. Amazwe angakhetha kwakhona ukuyisebenzisa njengomgangatho wokunyamekela abantwana ababhalise kwiNkqubo ye-Intshuwalense yezeMpilo (Children's Health Programme) (CHIP) . Ezinye iimeko, nangona kunjalo, zisebenzisa umgangatho ohlukileyo kwinkqubo ye-CHIP.
Oko Kufuneka Ukwazi NgeFom yeFomu 416
Amazwe abika ukuthabatha inxaxheba kunye nokuthotyelwa kwe-EPSDT ngokugqiba ifomu ebizwa ngokuba yiFom ye- CMS ifom 416 ngonyaka.
Ifomu iphula abantu baseMedicaid kwiindawo ezahlukahlukeneyo kwaye babuza ukuba bangaphi abo bantwana bafumana ukuhlolwa okanye unyango othile kulo nyaka.
Ifom ye-CMS 416 ivumela urhulumente wesigqeba ukuba agcine umkhondo kumsebenzi ngamnye welizwe. Ingcaciso ingasetyenziselwa ukubona apho (okanye ukuba) ichaza emva kwayo kwaye ingaba ithuba lokubakhokela ekuphuculeni ekuboneleleni ngoncedo oluyimfuneko.
Ingxaki kukuba idatha iqokelelwa kodwa ingasetyenziswanga kuyo.
Xa amazwe angazalanga ifom ye-CMS ifom 416 okanye xa engakwazi ukuhlangabezana nemigangatho ye-EPSDT, abahlawulwa ngamagumbi e-Medicare kunye neeNkonzo zeMedicaid (CMS).
Uphuculo lwe-EPSDT luza kungekhona ngenxa yokuba urhulumente wephondo unyanzela imithetho yayo. Ukuphuculwa kweza kwenzeka kuba abantu bayazimela. Ininzi yamacala omsebenzi eklasini athathwe ngokumelene namazwe ahlukeneyo ukuba afune ukunyamekela. Nangona iindawo ze-EPSDT zifinyeleleka, ukunakekelwa kwamazinyo, ukuboniswa kwenkcazo, kunye neenkonzo zempilo yengqondo yilapho apho kuthathwa khona inyathelo elisemthethweni.
Lapho i-EPSDT ihluleka kwiNyango yamaNyoko
Umlomo onempilo kubalulekile ukugcina ukutya okunempilo kunye nokuphila kakuhle kwengqondo. Ngelishwa, ama- abscesses amazinyo ngenye yezinto eziqhelekileyo abantwana abajamelana nazo.
Ngo-2014, iipesenti ezingama-48 kuphela zabantwana abafanelekileyo kwiMedicaid bafumana unyango lwamazinyo okukhusela kwaye xa ingxaki ichongwa, kuphela iipesenti ezingama-22 zanikwa unyango lwaloo mqathango.
Nokuba ukhangele kwizona zinto zilungileyo kakhulu, nazo zonke izifunda kunye neSithili sase-Columbia zibika, kuphela i-13 e-Arkansas, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Maryland, Massachusetts, Nebraska, South Carolina, Texas, IVermont, kunye neWashington-eyenziwa ngezantsi ukuya kuma-51 ukuya kuma-62 ekhulwini kwinqanaba leenkonzo zamathambo.
Xa kuziwa kunyango, amanani ayancipha. Amazwe aphezulu awenzayo, ukusuka kwi-25 ukuya kwe-52 ukuthotyelwa kwepesenti, ziquka i-Arkansas, iColorado, i-Connecticut, i-Idaho, iMassachusetts, i-Mississippi, i-New Jersey, iNew Mexico, i-Oklahoma, iTexas, i-Virginia, iWashington, ne-West Virginia.
Xa i-EPSDT ihluleka kwi-Screening Screen
Ukubonakalisa ukukhokela kunokukhokelela kwimiphumo emibi yempilo evela kwi- anemia ukuya kwiingxaki zokuziphatha kunye neurologic. I-EPSDT idinga ukuba abantwana ababhalise kwiMedicaid bahlolwe ukukhokela kwigazi labo kwiinyanga ezili-12 kunye neenyanga ezingama-24 ubudala.
Ngelishwa, emva kokuxhaswa kwemali kwiziko leZiko loLawulo lokuLawula nokuLawulwa kweMilwelwe kunye neNkokeli yokuCandwa koTyhefu kuphele ngo-2012, iindawo ezimbalwa ziye zanikela iinkcukacha ezicelwayo kurhulumente.
Idatha ye-Medicaid ka-2015 ibonisa ukuba kuphela iipesenti ezingama-38 zabantwana eziye zahlolwa kwiimilinganiselo zegazi njengoko zifunwa yi-EPSDT.
IKomiti yeSizwe yoQinisekiso loQiniso (NCQA), inhlangano engenzi nzuzo, ikhuphe idatha eqikelelwa ukuba kuphela i-66 ekhulwini yabantwana abaneminyaka emi-2 ubudala ababhalise kwiMedicaid bahlolwe amazinga okhokelo kwiminyaka emi-2 edlulileyo.
Lapho i-EPSDT ihluleka kwiNkonzo zezeMpilo yengqondo
Emva kokuba umntwana phakathi kweminyaka engama-6 ukuya kwe-20 ubudala uye wabhedelwa esibhedlele ngenxa yesifo sengqondo, ukufikelela kwiinkonzo zokuziphatha eziqhubekayo kunye neenkonzo zempilo yengqondo kubalulekile. I-EPSDT idinga ukuba abo babantwana babonakale ngokulandelelana kwiintsuku ezingama-7 zokukhutshwa kwezibhedlele.
Ngo-2014, ngokwemyinge, kuphela amaphesenti angama-44 abantwana abonwa ngokulandelelaniswa kwiintsuku ezingama-7 kunye neepesenti ezingama-65 kwiintsuku ezingama-30 zokubhedlelelwa esibhedlele.
Amazwe enza phezulu kwikhosi yokulandelelwa kweentsuku ezi-7 kuma-62 ukuya kuma-76 ekhulwini kuquka i-Iowa, i-Kansas, iMaine, iMassachusetts, i-Nevada, iNew York, i-Oregon, i-Rhode Island ne-Vermont, kodwa xa ifika kuma-30 -ukulandelelana-suku, utshintshe i-Iowa e-Indiana. Eli liqela lokugqibela lenza ama-78 ukuya kuma-91 ekhulwini.
Uninzi lwamachiza, ngokukodwa ukuvuselela, olusetyenziselwa ukunyamekela ingqalelo kwintlupheko yokuxhatshazwa kwempilo ineempembelelo. I-EPSDT idinga ukuba abantwana abachazwe la mayeza afunyanwe zingadlulanga iintsuku ezingama-30 ekuqalekeni kweyeza (iSigaba sokuQala) kwaye ukuba babonwa kabini kwiinyanga ezili-9 ezizayo (iSigaba sokuqhubeka kunye neSondlo).
Ngomhla wama-2014, i-state ibingaphezulu kwimizuzu engama-44 yokuphumelela kwisiGaba sokuQala kunye nama-57 ekhulwini kwiSigaba sokuPhucula nokuSondlo.
KwisiGaba sokuQala, i-Arkansas, i-Connecticut, i-Maine, i-New York, i-Ohio, i-Oklahoma, i-Oregon kunye ne-Rhode Island, kunye neVermont yenza okuphezulu kuma-53 ukuya kuma-69 ekhulwini ngelixa iSigaba sokuPhucula nokuSondeza sifike kwizinga eliphezulu lokuphumelela ukusuka kuma-63 ukuya kuma-84 e-Arkansas. , Connecticut, Maine, eNew York, eOhio, e-Rhode Island, eVermont naseWest Virginia.
Ikusasa leMedicaid
I-EPSDT sele ikhulile. Amazwe ahluleka ukubonelela ngononophelo lwabantwana kwimindeni engenamvuzo kunye neemvelaphi ezifunekayo kwaye zifanele, kwaye urhulumente wesigqeba akasayi kuthatha inyathelo.
Kubonakala sengathi lo mkhangeli awukwazi ukuphucula nayiphi na ixesha kungekudala.
Ulawulo lweTrump luneenkxaso-mali zombuso kwi-Medicaid kwii-crosshairs zayo. UMthetho we- American Health Care Act , njengoko wawuthiwa kwiNdlu yabameli be-US, wawuya kunciphisa inkxaso-mali ye-federal kwi-Medicaid ngama-dollar ayi-800 yezigidi ngaphezu kweminyaka eyi-10, echaphazela amandla karhulumente ukuba angaboneleli nje ngeenzuzo ze-EPSDT kodwa i-Medicaid inzuzo enkulu. Nangona le mithetho, kamva ibizwa ngokuba nguMthetho woLungelelwaniso loNxibelelwano olungcono, ayiphumelelanga ukuvota kwi-Senate, ibeka umzekelo wokufunwa kweMedicaid. Omnye umthetho unokucetyiswa endaweni yawo.
Oku kushiya amaMerika ukuba azibophe. Izigwegwe zenzo zamaklasi zinyanzele izandla zelizwe ukuba zenze into efanelekileyo. Nazi ezinye zeentetho ezisemthethweni eziye zadlala kwiminyaka yamuva.
- Emily Q vs. Bonta (California)
- I-Florida Pediatric Society / IFlorida Isahluko se-American Academy of Pediatrics v. Levine (Florida)
- IGD vs. Riley (Ohio)
- NB ngokumelene noNorwood (Illinois)
- I-Salazar kunye neSithili sase-Columbia (iSithili sase-Columbia)
Ngokuxhaswa ngemali engumngcipheko, lindela ukugwetywa kwamanyathelo eklasi kwixesha elizayo.
ILizwi
Urhulumente wezepolisi usethe igunya le-EPSDT ukuqinisekisa ukuba abantwana kwiMedicaid bafumana ukubaluleka kokunyamekela. Nangona kunjalo, akukho ncinane eyenziwa ukuqinisekisa ukuba amazwe aphila kwisithembiso eso. Ukuba umntwana wakho unqatshelwe unyameko phantsi kweMedicaid, yibeke le ngqalelo kwiSebe lakho lezeMpilo. Ukuba uqhubeka ufumana ukungaphumeleli, kusenokuba unomdla wokubonelela ukuba kukho i-suit action action kwilizwe lakho ukulungisa umba.
> Imithombo:
> Inkcazelo Yonyaka ka-2015 kuMgangatho wokuNakekela abantwana kwi-Medicaid ne-CHIP . Website yeMedicaid. https://www.medicaid.gov/medicaid/quality-of-care/downloads/2015-child-chart-pack.pdf. Upapashwe ngo-Agasti 2016.
> Ukujongana nokuLinga kweNgcaciso yeGazi kubantwana ababhalise kwiMedicaid kunye neNkqubo yeNtshuwalense yeMpilo yabantwana. Website Medicaid.gov. https://www.medicaid.gov/federal-policy-guidance/downloads/cib113016.pdf.
> UkuQala kwexesha eliPhezulu kunye noPhezulu lweNkcazo, ukuChengisisa nokuPhathwa nguRhulumente. IWebhusayithi yeSikolo soFundo neNgcaciso. https://eclkc.ohs.acf.hhs.gov/hslc/states/epsdt. Ukuhlaziywa ngo-Apreli 19, 2017.
> URaymond J, uBrown MJ. Amanqanaba oLawulo lweGazi kwi-Akhulile abantwana <5 iminyaka & mdash United State, 2007-2013. Ukuxhatshazwa kunye nokufa kweeVeki ngeveki (MMWR). Oktobha 2016, 63 (55); 66-72. i-doi: https://www.cdc.gov/mmwr/volumes/63/wr/mm6355a6.htm.
> Ukusetyenziswa kweeNkonzo zamazinyo kwi-Medicaid ne-CHIP . Website yeMedicaid. https://www.medicaid.gov/medicaid/benefits/downloads/secretarys-report-dental-excerpt.pdf. Epapashwe ngoJanuwari 2015.