Ama-Lawsuits Action Action ne-Future of Medicaid
Uma kuziwa ekunakekeleni izingane, i- Medicaid ichaza ukuthi yini edingekayo ukuze igcine iphilile. Ngo-1967, uhulumeni wesifundazwe wasungula Uhlelo Lokuqala Lokuhlola, Lokuhlola Nokulashwa (EPSDT), nemiphumela elandelayo:
- Ukuhlolwa kokuqala nangesikhathi esizayo : Ingane ngayinye inokufinyelela ekuvimbeleni nokuvimbela kahle okwenzeka esimisweni esimisiwe. Umgomo ukuthola izinkinga kusenesikhathi ukuze zilungiswe ngokushesha. Amasevisi afaka kodwa awanqunyelwe ukunakekelwa kwamazinyo, izivivinyo zokuzwa , ukugonywa, ukuhlolwa kokuhola , amasevisi ezempilo yengqondo, nokuhlolwa kombukiso.
- Ukuxilongwa : Kuzo zonke izivivinyo zokuhlola ezilinganiselwe noma ezihle, i-EPSDT idinga ukuba i-Medicaid igcwalise ukuhlolwa okungeziwe ukuqinisekisa ukuxilongwa.
- Ukwelapha : Noma yikuphi ukuxilongwa okuqinisekisiwe, i-EPSDT idinga ukuthi uhulumeni akhokhele ukwelashwa okudingekile, kungakhathaliseki ukuthi leyo nzuzo ingavamile ukumbozwa yi-Medicaid.
I-EPSDT iyinzuzo ephoqelekile ebeka phambili ukunakekelwa kokuvikela kanye nenhlalakahle kanye nesikhungo sabantwana. Kungumthwalo wombuso ngamunye ukuhlinzeka le nzuzo kubantwana nasebancane ababhalisile ohlelweni lweMedicaid baze baneminyaka engu-21 ubudala. Amazwe angakhetha futhi ukuyisebenzisa njengendlela yokunakekelwa kwabantwana ababhalisile ohlelweni lwabo lwe-Health Health Insurance (CHIP) . Abanye bathi, kodwa, basebenzisa izinga elihlukile lenhlelo ye-CHIP.
Okudingeka Ukwazi NgeFomu Ifomu 416
Amazwe abika ukuhlanganyela kwabo nokuhambisana ne-EPSDT ngokugcwalisa ifomu elibizwa ngeFomu le- CMS 416 unyaka ngamunye.
Ifomu lehlisa abantu baseMedicaid abe ngamaqembu ahlukene bese bebuza ukuthi bangaki kulabo bantwana abathola ukuhlolwa noma ukwelashwa okuthile kulowo nyaka.
I-CMS Ifomu 416 ivumela uhulumeni wesifundazwe ukuba alandele ukusebenza kombuso ngamunye. Lolu lwazi lungasetshenziselwa ukubona ukuthi (noma uma) kuthiwa liwela ngemuva futhi kungaba ithuba lokubaqondisa ekuthuthukiseni ekuhlinzekeni ukunakekelwa okudingekile.
Inkinga ukuthi idatha iqoqwe kodwa ingasetshenziselwa amandla ayo.
Uma amazwe engagcwalisi ifomu le-CMS Ifomu 416 noma uma engakwazi ukuhlangabezana namazinga e-EPSDT, ahlawuliswa yi-Centers for Medicare neMediicaid Services (CMS).
Ukuthuthukiswa ku-EPSDT kuvela hhayi ngenxa yokuthi uhulumeni wesifundazwe uqinisa imithetho yawo. Ukuthuthukisa kuvela ngoba abantu bayazimela. Izigameko eziningana zezigameko zesigaba ziye zalethwa ezizweni ezahlukene ukuze zidinga ukunakekelwa okwakuthenjisiwe. Nakuba izindawo ze-EPSDT zifinyelelekile, ukunakekelwa kwamazinyo, ukuhlolwa kokuhola, nezinsizakalo zempilo yengqondo yilapho okuye kwenziwa khona isenzo esingokomthetho kunazo zonke.
Lapho i-EPSDT ihluleka ukunakekelwa kwamazinyo
Umlomo ophilile ubalulekile ukugcina ukudla okunempilo nokuphila kahle kwengqondo. Ngeshwa, ama-abscesses amazinyo angenye yezindaba ezivame kakhulu izingane ezibhekana nazo.
Ngo-2014, amaphesenti angu-48 kuphela abantwana abafanelekile eMedicaid bathola ukunakekelwa kwamazinyo okuvimbela futhi uma inkinga ibonakala, amaphesenti angu-22 kuphela athola ukwelashwa kwalesi simo.
Ngisho nalapho ubheka okungcono kunazo zonke, nazo zonke izifunda kanye nesifunda sase-Columbia, kubika kuphela i-Arkansas, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Maryland, Massachusetts, Nebraska, South Carolina, eTexas, I-Vermont ne-Washington-eyenziwa ngamaphesenti angu-51 kuya kwangu-62 ephansi ngamasevisi amazinyo okuvimbela.
Uma kuziwa ekwelapheni, izinombolo ziyamangalisa kakhulu. I-top performing states, kusukela ekuthomeni kokulinganisa kuka-25 kuya kwangu-52, kufaka i-Arkansas, i-Colorado, i-Connecticut, i-Idaho, iMassachusetts, i-Mississippi, i-New Jersey, i-New Mexico, i-Oklahoma, iTexas, i-Virginia, i-Washington ne-West Virginia.
Lapho i-EPSDT ihluleka ekuhlolweni kokuhola
Ukuvezwa kokuhola kungaholela emiphumeleni eyingozi yezempilo kusukela ekuphefumuleni kwegazi kuya ekuhluphekeni kokuziphatha kanye neurologic. I-EPSDT idinga ukuthi izingane ezibhalise ku-Medicaid zihlolwe ukuhola egazini labo ezinyangeni ezingu-12 nezinyanga ezingu-24 ubudala.
Ngeshwa, emva kokuxhasa ngemali e-Federal Center for Disease Control and Prevention's Healthy Homes Program and Program Lead Prevention Poisoning Prevention ngo-2012, izimbalwa ezimbalwa zinikeze idatha eceliwe kuhulumeni.
Idatha ye-Medicaid ka-2015 ibonisa ukuthi amaphesenti angu-38 kuphela ezingane ahlolwe amazinga okuhola igazi njengoba kudingwa yi-EPSDT igunya.
Ikhomishana kaZwelonke yokuQinisekiswa kweQiniso (NCQA), inhlangano engeyona inzuzo, ikhishwe idatha ekulinganiseni ukuthi kuphela amaphesenti angu-66 abantwana abaneminyaka emibili ubudala ababhalise eMedicaid bahlolwe amazinga okuhola eminyakeni emibili eyedlule.
Lapho i-EPSDT ihluleka khona eNkonzweni Yempilo Yengqondo
Uma ingane iseneminyaka engama-6 kuya kwengu-20 isesibhedlela ngenxa yesifo sengqondo, ukutholakala kwezinsizakalo zokuziphatha eziqhubekayo nezempilo kubalulekile. I-EPSDT idinga ukuthi lezi zingane zibonwe ekulandeleni zingakapheli izinsuku ezingu-7 zokukhishwa kwezibhedlela.
Ngo-2014, ngokwesilinganiso, kuphela amaphesenti angu-44 kuphela abantwana abonakala ekulandeleni kwezinsuku ezingu-7 namaphesenti angu-65 zingakapheli izinsuku ezingu-30 zokugula esibhedlela.
Amazwe enza phezulu kweklasi ukulandelwa kwezinsuku ezingu-7 ngamaphesenti angama-62 kuya kwangu-76 ahlanganisa i-Iowa, i-Kansas, i-Maine, iMassachusetts, i-Nevada, i-New York, i-Oregon, i-Rhode Island ne-Vermont, kodwa uma kuziwa kuma-30 -day ukulandela-up, shintsha Iowa for Indiana. Leli qembu lenza amaphesenti angu-78 kuya kwangu-91.
Imithi eminingi, ikakhulukazi ezishukumisayo, esetshenziselwa ukunakekelwa kokunciphisa ukugula kwengqondo inezimo ezimbi. I-EPSDT idinga ukuthi izingane ezinqunywe le mithi zibonwe zingakapheli izinsuku ezingu-30 zokuqala imithi (Isigaba sokuqala) nokuthi zibonwe kabili ezinyangeni ezingu-9 ezizayo (Isigaba sokuqhubeka nesondlo).
Ngonyaka ka-2014, lezi zibalo zalinganiselwa kuphela ngamaphesenti angu-44 izinga lokuphumelela eSigaba sokuQala kanye namaphesenti angu-57 eSigaba Sokuqhubeka Nokusondeza.
I-Phase Lokuqala, i-Arkansas, i-Connecticut, i-Maine, i-New York, i-Ohio, i-Oklahoma, i-Oregon ne-Rhode Island, ne-Vermont yenza ngaphezulu kwamaphesenti angu-53 kuya kwangu-69 ngenkathi iSigaba sokuqhubeka nesondlo sathola amazinga aphezulu okuphumelela kusuka kumaphesenti angu-63 kuya kwangu-84 e-Arkansas , Connecticut, Maine, New York, Ohio, Rhode Island, Vermont, naseWest Virginia.
Ikusasa Lokuxilongwa
I-EPSDT isivele ihlukumezekile. Amazwe ahluleka ukuhlinzeka izingane zokunakekela ezivela emindenini engenayo engenayo kanye nezizinda ezidinga futhi zifanelwe, kanti uhulumeni wesifundazwe usazothatha isinyathelo.
Kubonakala sengathi lo mkhuba awunakwenzeka ukuthuthukisa noma kunini isikhathi.
Isiphathimandla seTrump sinemali ehambisana ne-Medicaid e-crosshairs yayo. I- American Health Care Act ehlongozwayo, njengoba ibizwe ngeNdlu yabaMamele base-United States, ngabe isinciphise ukuxhasa ngemali ku-Medicaid nge $ 800 billion ngaphezu kweminyaka eyishumi, okwenza amandla kahulumeni anganikezeli nje kuphela izinzuzo ze-EPSDT kepha izinzuzo ze-Medicaid ziningi. Nakuba lo mthetho, obizwa ngokuthi yi-Better Care Reconciliation Act, ohlulekile ukuvota eSenate, ubeka isibonelo sokudinga iMedicaid. Omunye umthetho ungahle uhlongozwe endaweni yawo.
Lokhu kushiya abaseMelika ukuzibophezela. Izigameko zesenzo sekilasi ziye zaphoqelela izandla zamazwe ukwenza into efanele. Nazi ezinye zezinsolo ezivelele eziye zadlala eminyakeni 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 vs. Norwood (Illinois)
- Salazar vs. District of Columbia (District of Columbia)
Ngokuxhaswa ngemali engxenyeni ye-Medicaid engozini, lindela izigwegwe eziningi zesigaba esilandelayo esikhathini esizayo.
Izwi elivela
Uhulumeni kahulumeni wabeka igunya le-EPSDT ukuqinisekisa ukuthi izingane ezibhekene neMedicaid zithola ukunakekelwa okubalulekile, ikhwalithi yokuvimbela ikhwalithi. Kodwa-ke, kukhona okuncane okwenziwe ukuqinisekisa ukuthi lezi zizwe ziphila ngokuvumelana nesithembiso. Uma ngabe ingane yakho inqatshelwe ukunakekelwa ngaphansi kweMithi, yenza lokhu kuqondwe uMnyango Wezempilo wombuso wakho. Uma uqhubeka ukuthola ukuthola ukwehluleka, kungase kube okuthakazelisayo kakhulu ukubona ukuthi kukhona yini isenzo senqubo yesifunda esifundazweni sakho sokuxazulula inkinga.
> Imithombo:
> Umbiko wonyaka wonyaka we-2015 on Quality of Care for Children in Medicaid and CHIP . Iwebhusayithi ye-Medicaid. https://www.medicaid.gov/medicaid/quality-of-care/downloads/2015-child-chart-pack.pdf. Kushicilelwe ngo-Agasti 2016.
> Ukuhlolwa kokuhlolwa kwegazi kwezingane ezibhalisiwe kwi-Medicaid kanye ne-Child Health Insurance Program. Iwebhusayithi yakwaMedicaid.gov. https://www.medicaid.gov/federal-policy-guidance/downloads/cib113016.pdf.
> Ukuhlola Isikhathi Sokuqala Nesikhathi Esivamile, Ukuhlonza Nokuphathwa Kwesifundazwe. Iwebhusayithi ye-Learning and Knowledge Centre yasekuseni. https://eclkc.ohs.acf.hhs.gov/hslc/states/epsdt. Kubuyekezwe ngo-Ephreli 19, 2017.
> Raymond J, Brown MJ. Amazinga Okuhola Ezinganeni Ekhulile
> Ukusetshenziswa kwezinsizakalo zamazinyo ku-Medicaid ne-CHIP . Iwebhusayithi ye-Medicaid. https://www.medicaid.gov/medicaid/benefits/downloads/secretarys-report-dental-excerpt.pdf. Kushicilelwe ngoJanuwari 2015.