Likarolo tsa Liketso tsa Sehlopha le Bokamoso ba Tlhahlobo
Ha ho tluoa tabeng ea ho hlokomela bana, Medicaid e hlalosa se hlokahalang ho ba boloka ba phetse hantle. Ka 1967, mmuso oa 'muso o thehile lenaneo la pele la ho hlahloba, la ho hlahloba le la tlhokomelo (EPSDT), le liphello tse latelang:
- Ho hlahloba nako le nako le nako : Ngoana e mong le e mong o na le monyetla oa ho itšireletsa le ho ba hlokolosi ho etsahalang kemiso e behiloeng. Sepheo ke ho lemoha mathata mathoasong e le hore ba ka khalemeloa kapele. Litšebeletso li kenyelletsa empa ha li felle feela ho tlhokomelo ea meno, liteko tsa ho utloa , liente tsa mantlha, ho hlahlojoa ka pele , litšebeletso tsa bophelo ba kelello le ho hlahloba pono.
- Tlhahlobo : Bakeng sa liteko tsa ho hlahloba tse fapaneng kapa tse ntle, EPSDT e hloka hore Medicaid e phethe liteko tse eketsehileng ho netefatsa hore o fumaneha.
- Phekolo : Bakeng sa ho hlahlojoa ha mofuta leha e le ofe o tiisitsoeng, EPSDT e hloka hore naha e lefelle phekolo e hlokahalang, ho sa tsotellehe hore na molemo oo o ke ke oa koaheloa ke Medicaid.
EPSDT ke phaello e laetsoeng e behang pele le tlhokomelo ea tlhokomelo ea boiketlo le bana bakeng sa bana. Ke boikarabelo ba mmuso ka mong ho fana ka molemo ona ho bana le bacha ba ngolisitseng lenaneong la Medicaid ho fihlela ba le lilemo li 21. Linaha li ka boela tsa khetha ho li sebelisa e le tekanyetso ea tlhokomelo bakeng sa bana ba ngolisitseng Lenaneong la Inshorense ea Bophelo ba Bana (CHIP) . Ba bang ba re, leha ho le joalo, ba sebelisa litekanyetso tse sa tšoaneng bakeng sa lenaneo la CHIP.
Seo U Lokelang ho se Tseba ka Fomu ea CMS 416
Linaha li tlaleha hore li kenya letsoho le ho latela melao ea EPSDT ka ho tlatsa foromo e bitsoang CMS Formula 416 selemo le selemo.
Sebopeho sena se senya batho ba Medicaid hore e be lihlopha tse fapaneng 'me joale ba botsa hore na ba bakae ba bana bao ba fumanoeng ho hlahlojoa kapa phekolo e itseng ka selemo seo.
CMS Foromo ea 416 e lumella 'muso oa' muso hore o boloke lipatlisiso mosebetsing oa 'muso. Boitsebiso bo ka sebelisoa ho bona moo (kapa haeba) e bolelang hore e oa morao 'me e ka ba monyetla oa ho ba tataisetsa ho ntlafatsa ho fana ka tlhokomelo e hlokahalang.
Bothata ke hore boitsebiso bo bokelloa empa ha bo sebelisoe boemong ba bona.
Ha litlaleho li sa tlatse Fomomo ea 416 kapa ha li haelloa ke litekanyetso tsa EPSDT, ha li ahloleloe ke Li-Centers tsa Medicare le Medicaid Services (CMS).
Ntlafatso ea EPSDT ha e tlisoe ke hobane muso oa muso o hatisa melao ea oona. Ntlafatso e ba teng kahobane batho ba ikemela. Likamano tse 'maloa tsa liketso tsa sehlopha li' nile tsa tlisoa khahlanong le mefuta e fapaneng ea ho batla tlhokomelo eo ba e tšepisitsoeng. Le hoja libaka tsa EPSDT li se li le khutšoanyane, tlhokomelo ea meno, ho hlahloba pele, le litšebeletso tsa bophelo bo botle ba kelello ke tsona moo ho nkoang khato ea molao ka ho fetisisa.
Moo EPSDT e hlōlehang ho hlokomeloa meno
Molomo o phetseng hantle o bohlokoa ho boloka phepo e nepahetseng le boiketlo ba kelello. Ka bomalimabe, ho senyeha ha meno ke e 'ngoe ea mathata a tloaelehileng ao bana ba tobanang le' ona.
Ka 2014, karolo ea 48 lekholong feela ea bana ba tšoanelehang ho Medicaid e ile ea fumana tlhokomelo ea meriana e thibelang 'me ha bothata bo fumanoa, ke liphesente tse 22 feela tse ileng tsa fumana phekolo ea boemo boo.
Esita le ha u sheba se setle ka ho fetisisa, ka litlaleho tsohle le Seterekeng sa Columbia ho tlaleha, ke 13 feela e bolelang-Arkansas, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Maryland, Massachusetts, Nebraska, South Carolina, Texas, Vermont, le Washington-e etsoang ka tlaase ho 51 ho isa ho 62 lekholong bakeng sa litšebeletso tsa meno ea tšireletso.
Ha e tluoa tabeng ea phekolo, linomoro li bile li tsoteha haholo. Mantsoe a phahameng a ho etsa, ho tloha pakeng tsa 25 le 52 lekholong, a kenyeletsa Arkansas, Colorado, Connecticut, Idaho, Massachusetts, Mississippi, New Jersey, New Mexico, Oklahoma, Texas, Virginia, Washington le West Virginia.
Moo EPSDT e hlōlehang ho hlahloba Moeta-pele
Ho ipeha kotsing ea ho etella pele ho ka lebisa liphellong tse tebileng tsa bophelo bo botle ho tloha ho mali ho tsoa ho maloetse ho ea ho boitšoaro bo bobe le ba methapo ea maikutlo. EPSDT e hloka hore bana ba ngolisitseng Medicaid ba hlahlojoe bakeng sa tataiso maling a bona ka likhoeli tse 12 le likhoeli tse 24.
Ka bomalimabe, ka mor'a hore ho fuoe lichelete tsa feme bakeng sa Setsi sa Mahae a Bophelo le Thibelo ea Maloetse le Lenaneo la Thibelo ea Chefo e phethiloeng ka 2012, linaha tse 'maloa li fane ka boitsebiso bo eang ho' muso.
Litaba tsa Medicaid tsa 2015 li bontša hore karolo ea 38 lekholong feela ea bana e ne e hlahlojoe bakeng sa maemo a tsamaiso ea mali joalokaha ho hlokoa ke taolo ea EPSDT.
Komiti ea Naha ea Tlhahiso ea Boleng (NCQA), mokhatlo o sa lefelloeng phaello, ho lokolloa boitsebiso bo bontšang hore ke karolo ea 66 lekholong ea bana ba lilemo li peli feela ba ngolisitseng Medicaid ba ile ba hlahlojoa ka litekanyetso tsa tataiso lilemong tse 2 tse fetileng.
Moo EPSDT e hlōlehang Litšebeletso tsa Bophelo ba kelello
Hang ha ngoana ea lilemo li pakeng tsa 6 le 20 a se a le sepetlele ka lebaka la boloetse ba kelello, ho ba le litšebeletso tse tsoelang pele tsa boitšoaro le tsa kelello ke tsa bohlokoa. EPSDT e hloka hore bana bana ba bonoe ka morao-pele matsatsing a supileng ka mor'a ho hlakoloa ha bona sepetlele.
Bakeng sa 2014, ka karolelano, ke karolo ea 44 lekholong feela ea bana e ileng ea bonoa ka morao ho feta matsatsi a 7 le karolo ea 65 lekholong pele ho matsatsi a 30 a lefu la kelello.
Linaha tse etsang karolo e ka holimo ea tlelase bakeng sa ts'ebetso ea matsatsi a 7 lilemong tse 62 ho ea ho 76 li kenyeletsa Iowa, Kansas, Maine, Massachusetts, Nevada, New York, Oregon, Rhode Island le Vermont, empa ha e fihla ho ba 30 Letsatsi la morao-rao, o fetola Iowa bakeng sa Indiana. Sehlopha sa bobeli se ile sa etsa karolo ea 78 ho isa ho 91 lekholong.
Meriana e mengata, haholo-holo e tsosang maikutlo, e sebelisetsoang ho hlokomela tlhokomelo ea tlhokomelo ea ho kula ho na le litla-morao. EPSDT e hloka hore bana ba behe meriana ena pele ho matsatsi a 30 ho qala meriana (Initiation Phase) le hore joale ba bonoa habeli likhoeling tse 9 tse latelang (Phaello ea Ts'ebetso le Maintenance Phase).
Bakeng sa selemo sa 2014, karolo ea 44 lekholong ea katleho ea Phase ea Phaello le karolo ea 57 lekholong ea Phalliso le Tlhokomelo.
Bakeng sa Phase ea Tšimoloho, Arkansas, Connecticut, Maine, New York, Ohio, Oklahoma, Oregon le Rhode Island, le Vermont e ne e phahame ka holimo ho 53 ho ea ho 69% ha Phaello ea Tsoelo-pele le Maintenance e fihlile katleho e kholo ho tloha ho 63 ho isa ho 84 lekholong Arkansas , Connecticut, Maine, New York, Ohio, Rhode Island, Vermont le West Virginia.
Bokamoso ba Tlhahlobo
EPSDT e se e ntse e loana. Linaha li hlōleha ho fana ka bana ba tlhokomelo malapeng a meputso e tlaase le limelo li hloka le ho tšoaneloa, 'me' muso oa 'muso o sa ntse o lokela ho nka khato.
Ho bonahala eka mokhoa ona ha o khone ho ntlafatsa nako leha e le efe kapele.
Lefapha la tsamaiso ea Trump le na le lichelete tsa federal bakeng sa Medicaid li-crosshairs tsa eona. Sepheo se entsoeng ho American Health Care Act , joalokaha se ne se bitsoa ka ntlo ea Boemeli ba US, se ka fokotsa lichelete tsa federal ho Medicaid ka liranta tse limilione tse likete tse 800 ho feta lilemo tse 10, e leng ho susumetsang bokhoni ba mmuso ho fana ka melemo ea EPSDT feela empa melemo ea meriana e ruisa molemo ka ho fetisisa. Le hoja molao ona, oo hamorao o bitsoang Molao oa Better Care Reconciliation Act, o ile oa hlōleha ho fetisetsa likhetho Senate, o beha mohlala oa ho batla Médicaid. Molao o mong o ka fanoa sebakeng sa oona.
Sena se siea Maamerika ho iketsetsa. Linyeoe tsa liketso tsa lihlopha li qobelletse matsoho a linaha ho etsa ntho e nepahetseng. Tse ling tsa linyeoe tse hlaheletseng tse hlahisitsoeng lilemong tsa morao tjena.
- Emily Q vs. Bonta (California)
- Society of Florida Pediatric / The Florida Khaolo ea American Academy of Pediatrics v. Levine (Florida)
- GD vs. Riley (Ohio)
- NB vs. Norwood (Illinois)
- Salazar vs. Setereke sa Columbia (Setereke sa Columbia)
Ka lithuso tsa lichelete tsa Medicaid kotsing, lebeletse linyeoe tse ngata tsa likarolo nakong e tlang.
Lentsoe le Tsoang ho
'Muso oa' Muso o behile taelo ea EPSDT ho netefatsa hore bana ba Medicaid ba fumana tlhokomelo e hlokahalang, boleng ba tšireletso. Leha ho le joalo, ho na le ho honyenyane ho etsoang ho tiisa hore linaha li phela tumellanong le tšepiso eo. Haeba ngoana oa hau a haneloa tlhokomelo tlas'a Medicaid, tlisa sena tlhokomelong ea Lefapha la Bophelo la naha ea hau. Haeba o tsoela pele ho fumana bofokoli, ho ka 'na ha e-ba le thahasello ea hau ho bona hore na ho na le seaparo sa khato sebakeng sa hau ho rarolla bothata.
> Mehloli:
> Selemo sa selemo sa 2015 sa Tlhokomelo ea Bana ho Medicaid le CHIP . Websaeteng ea Medicaid. https://www.medicaid.gov/medicaid/quality-of-care/downloads/2015-child-chart-pack.pdf. E hatisitsoe ka 2016.
> Koetliso ea ho hlahlojoa ha mali ho bana ba ngolisitsoeng Medicaid le Lenaneo la Inshorense ea Bophelo ba Bana. Websaete ea Medicaid.gov. https://www.medicaid.gov/federal-policy-guidance/downloads/cib113016.pdf.
> Tlhahlobo ea pele le ea nako e telele, ho hlahloba le ho phekola ka Naha. Websaeteng ea Bocha ea ho Ithuta le ea Tsebo ea Bana. https://eclkc.ohs.acf.hhs.gov/hslc/states/epsdt. E hlalositsoe ka la 19 April, 2017.
> Raymond J, Brown MJ. Maemo a Bolaoli ba Mali ho Bana ba Hōlileng
> Tšebeliso ea Litšebeletso tsa Meno ka Medicaid le CHIP . Websaeteng ea Medicaid. https://www.medicaid.gov/medicaid/benefits/downloads/secretarys-report-dental-excerpt.pdf. E hatisitsoe ka January 2015.