Milandu Yamilandu Yotsutsa ndi Tsogolo la Medicaid
Ponena za kusamalira ana, Medicaid imatanthauzira zomwe zimatengera kuti akhale ndi thanzi labwino. Mu 1967, boma linakhazikitsidwa pulogalamu yoyambirira, yowonongeka ndi yochizira (EPSDT), ndi zotsatira zotsatirazi:
- Kusanthula koyambirira ndi nthawi : Mwana aliyense ali ndi mwayi wothandiza komanso wodzisamalira zomwe zimachitika pa ndondomeko yake. Cholinga ndikutulukira mavuto oyambirira kuti athe kuwongolera mwamsanga. Ntchito zimaphatikizapo koma sizingatheke kumasamalidwe a mano, kuyesedwa kwa kumva , katemera, kuwonetsetsa kutsogolo , mautumiki apatsitsimutso, ndi kuyang'ana masomphenya.
- Kuzindikira : Kuyezetsa kulikonse komwe kuli malire kapena okongola, EPSDT imafuna kuti Medicaid athetse mayeso ena kuti atsimikizidwe kuti ali ndi matenda.
- Chithandizo : Pa matenda alionse omwe amatsimikiziridwa, EPSDT imafuna kuti boma lilipereke chithandizo chofunikira, mosasamala ngati kupindulako sikungapangidwe ndi Medicaid.
EPSDT ndi phindu lovomerezeka lomwe limapereka kutsogolo ndi chisamaliro cha chithandizo kwa ana. Ndi udindo wa boma lirilonse kupereka phindu limeneli kwa ana ndi achinyamata omwe amalembera pulogalamu ya Medicaid mpaka ali ndi zaka 21. Mayiko angasankhenso kugwiritsira ntchito monga chiwerengero cha chisamaliro cha ana omwe analembetsa mu Dipatimenti ya Inshuwalansi ya Zaumoyo ya Ana (CHIP) . Ena amati, komabe, amagwiritsa ntchito zosiyana pa pulogalamu ya CHIP.
Zimene Mukuyenera Kudziwa Zokhudza Fomu ya CMS 416
Mayiko akunena kuti amachita nawo mbali ndikutsatira EPSDT polemba fomu yotchedwa CMS Form 416 chaka chilichonse.
Mawonekedwewa amathetsa chiwerengero cha anthu a Medicaid kukhala a zaka zosiyana siyana ndikufunsa ana angati omwe adalandira kuwunika kapena kuchipatala komweku chaka chomwecho.
CMS Fomu 416 imalola boma la boma kuti lizilemba pa ntchito iliyonse ya boma. Zomwe mungagwiritse ntchitozi zingagwiritsidwe ntchito poona kuti (kapena ngati) zikutsika kumbuyo ndipo zikhoza kukhala mwayi wowatsogolera kuwongolera powapatsa chisamaliro chofunikira.
Vuto ndiloti deta imasonkhanitsidwa koma siigwiritsidwe ntchito pazitha zake.
Pamene mayiko samaliza CMS Fomu 416 kapena ngati sakulephera kukwaniritsa miyezo ya EPSDT, iwo samangidwa ndi Centers for Medicare ndi Medicaid Services (CMS).
Kupititsa patsogolo ntchito ku EPSDT kumabwera osati chifukwa boma la boma likukhazikitsa malamulo ake. Kupititsa patsogolo kumabwera chifukwa chakuti anthu amadziyimira okha. Milandu yambiri yazitsulo yadzaperekedwa motsutsana ndi mayiko osiyanasiyana kuti afunire chisamaliro chomwe analonjezedwa. Ngakhale madera a EPSDT atha kuchepa, kusamalira mano, kutsogolera kutsogolo, ndi chithandizo cha matenda a maganizo ndiwo omwe amachitidwa milandu kwambiri.
Kumene EPSDT Imalephera Kusamalira Manyowa
Pakamwa pabwino ndi kofunikira kuti mukhale ndi zakudya zabwino komanso maganizo abwino. Mwamwayi, kuperewera kwa mano ndi chimodzi mwa mavuto omwe ana amakumana nawo.
Mu 2014, ana 48 peresenti ya ana oyenerera pa Medicaid adalandira chisamaliro chapadera cha mano ndipo pamene vuto linazindikiridwa, 22 peresenti yokha idalandira chithandizo cha chikhalidwe chimenecho.
Ngakhale mutayang'ana bwino kwambiri, ndi mayiko onse ndi District of Columbia, malipoti 13, Arkansas, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Maryland, Massachusetts, Nebraska, South Carolina, Texas, Vermont, ndi Washington-yomwe inagwira ntchito yochepa kwambiri mpaka 51 mpaka 62 peresenti ya machitidwe opatsirana a mano.
Pankhani ya chithandizo, nambalayi ndi yosangalatsa kwambiri. Kuchita masewerowa, kuyambira pa 25 mpaka 52 peresenti, kumaphatikizapo Arkansas, Colorado, Connecticut, Idaho, Massachusetts, Mississippi, New Jersey, New Mexico, Oklahoma, Texas, Virginia, Washington, ndi West Virginia.
Kumene EPSDT imalephera kuwunika
Kuwonetsetsa kutsogolera kungayambitse matenda aakulu chifukwa cha kuchepa kwa magazi m'thupi kupita ku zovuta za khalidwe ndi za m'mimba. EPSDT imafuna kuti ana olembera ku Medicaid azisankhidwa kuti atsogolere m'magazi awo pamwezi 12 ndi miyezi 24.
Mwamwayi, mutatha thandizo la ndalama ku federal Center for Disease Control and Prevention Housing and Programme Prevention Poisoning Prevention Programme inatha mu 2012, mayiko ochepa apereka deta yopempha kwa boma.
Deta ya Medicaid ya 2015 imasonyeza kuti ana 38 peresenti ya ana anali atasankhidwa kuti azitsogoleredwa ndi magazi malinga ndi lamulo la EPSDT.
Komiti ya National Quality Assurance (NCQA), bungwe lopanda ntchito, lomwe linamasulidwa deta loyesa kuti 66 peresenti ya ana a zaka ziwiri omwe analembera ku Medicaid adayesedwa kuti azitsogoleredwa zaka ziwiri zapitazo.
Kumene EPSDT imalephera mu Zithandizo Zamankhwala Amaganizo
Mwana akakhala pakati pa zaka 6 ndi 20 wakhala ali kuchipatala chifukwa cha matenda aumphawi, kupezeka kwa machitidwe opitilirapo ndi zaumoyo n'kofunikira. EPSDT imafuna kuti ana awa awoneke pakutsata masiku asanu ndi awiri kuchokera pakutha kwachipatala.
Kwa 2014, pafupifupi, ana 44 peresenti ya ana anawonekeratu m'masiku asanu ndi awiri ndi 65 peresenti m'masiku 30 a chipatala chifukwa cha matenda a m'maganizo.
Mayiko omwe akukwera pamwamba pa maphunzirowa kwa masiku asanu ndi awiri (62) mpaka 76% ndi Iowa, Kansas, Maine, Massachusetts, Nevada, New York, Oregon, Rhode Island, ndi Vermont, koma zikafika pa 30 -kutsatira-tsiku, kusinthanitsa Iowa ku Indiana. Gulu lachiwirili linagwira ntchito pa 78 mpaka 91 peresenti.
Mankhwala ambiri, makamaka otsitsimutsa, ankakonda kuchepetsa vuto la kusokonezeka kwa matenda ndi matenda. EPSDT imafuna kuti ana adziwe kuti mankhwalawa akuwoneka mkati mwa masiku 30 kuchokera pamene ayamba kumwa mankhwala (Initiation Phase) ndipo amawoneka kawiri mu miyezi 9 ikutsatira (Kupitiriza ndi Kukonza Gawo).
Kwa 2014, chiwerengero cha 44% chinapindulitsa pa Pulogalamu ya Initiation ndipo 57 peresenti ya Phazi la Kupitiriza ndi Kusamalira.
Gawo la Initiation Phase, Arkansas, Connecticut, Maine, New York, Ohio, Oklahoma, Oregon, ndi Rhode Island, ndipo Vermont inapambana kwambiri pa 53 mpaka 69 peresenti pamene gawo la Continuation and Maintenance Phase linapambana kwambiri kuyambira 63 mpaka 84 peresenti ku Arkansas , Connecticut, Maine, New York, Ohio, Rhode Island, Vermont, ndi West Virginia.
Tsogolo la Medicaid
EPSDT yayamba kale kuvutika. Mayiko akulephera kupereka chisamaliro kwa ana kuchokera kumabanja omwe ali ndi ndalama zochepa komanso maziko akusowa ndi oyenerera, ndipo boma liyenera kuchitapo kanthu.
Zikuwoneka kuti zimenezi sizikuwoneka bwino posachedwa.
Dipatimenti ya Trump ili ndi ndalama zothandizira boma la Medicaid m'makampani ake. Cholinga cha American Health Care Act , monga momwe chinatchulidwira ku Nyumba ya Oimira a US, chikanachepetsa malipiro a federal ndi madola 800 biliyoni pa zaka khumi, zomwe zimakhudza mphamvu za boma kuti zisaperekedwe kokha kwa EPSDT koma Medicaid imapindula kwambiri. Ngakhale kuti lamuloli, lomwe linadzatchedwanso Better Care Reconciliation Act, linalephera kupititsa voti ku Senate, limapereka chitsanzo chofunira Medicaid. Lamulo lina likhoza kuperekedwa m'malo mwake.
Izi zimachititsa Achimereka kuti azidzipangira okha. Milandu yazitsamba zapachikale yanyengerera manja a mayiko kuchita zabwino. Nawa ena mwa milandu yowonjezereka yomwe yakhala ikuchitika m'zaka zaposachedwa.
- Emily Q vs. Bonta (California)
- Florida Pediatric Society / The Florida Chaputala cha American Academy of Pediatrics v. Levine (Florida)
- GD vs. Riley (Ohio)
- NB vs. Norwood (Illinois)
- Salazar vs. District ya Columbia (District of Columbia)
Pogwiritsa ntchito ndalama zowonongeka, onetsetsani kuti milandu yambiri ya m'kalasi idzachitike.
Mawu Ochokera
Boma la federal linakhazikitsa udindo wa EPSDT kuti atsimikizire kuti ana pa Medicaid amalandira chisamaliro chofunikira, chithandizo chodziletsa. Komabe, pali zochepa zomwe zikuchitika kuti zitsimikizire kuti izi zikugwirizana ndi lonjezolo. Ngati mwana wanu akuletsedwa chisamaliro pansi pa Medicaid, bweretsani izi ku Dipatimenti ya Zaumoyo yanu. Ngati mupitilira kupeza zofooka, zingakhale zofunikira kuti muwone ngati pali suti yogwira ntchito m'boma lanu kuti muthe kuthetsa vutoli.
> Zotsatira:
> Chaka Chotsatira cha 2015 cha Kusamalira Ana mu Medicaid ndi CHIP . Webusaiti ya Medicaid. Chiwongoladzanja Inasindikizidwa mu August 2016.
Kuchuluka kwa Kuyezetsa magazi Poyesa ana Kulembetsa ku Medicaid ndi Pulogalamu ya Inshuwalansi ya Ana. Webusaiti ya Medicaid.gov. https://www.medicaid.gov/federal-policy-guidance/downloads/cib113016.pdf.
> Kuyambira Kale ndi Kuwonetsa Nthaŵi Zonse, Kuzindikira ndi Kuchiza ndi State. Webusaiti Yoyambira ndi Kuphunzira za Achinyamata. https://eclkc.ohs.acf.hhs.gov/hslc/states/epsdt. Idasinthidwa pa April 19, 2017.
> Raymond J, Brown MJ. Mtsogoleri Wotsogolera Magazi M'mabanja Okalamba
> Kugwiritsira ntchito ma Dental Services ku Medicaid ndi CHIP . Webusaiti ya Medicaid. Chiwongoladzanja Yalembedwa January 2015.