Class Action Lawsuits da Future of Medicaid
Yayin da yake kula da yara, Medicaid ya bayyana abin da yake bukata don kiyaye su lafiya. A shekara ta 1967, gwamnatin tarayya ta kafa shirin farko da dubawa, maganin cutar da jiyya (EPSDT), tare da sakamakon wadannan:
- Farawa na farko da na lokaci-lokaci : Kowane yaro yana da damar yin amfani da kariya da kulawa da ke faruwa a lokacin tsarawa. Manufar ita ce gano matsalolin da wuri don a iya gyara su da wuri. Ayyuka sun hada da amma ba'a iyakance ga kulawa na hakori, gwaje-gwaje da jinni , maganin rigakafin rigakafi, sarrafawar jagoranci , sabis na kiwon lafiya na tunani, da kuma nuni hangen nesa.
- Binciken da aka gano : Domin duk wani gwaje-gwaje da ke nuna iyaka ko mai kyau, EPSDT yana buƙatar Medicaid kammala ƙarin gwaji don tabbatar da ganewar asali.
- Jiyya : Ga duk wani asirin da aka tabbatar, EPSDT na buƙatar jihar ta biya wajan magani, ko da kuwa idan ba Medicaid zai ci gaba da amfani da ita ba.
EPSDT kyauta ne mai amfani da ke sanya kariya da kula da lafiyar yara da kuma kula da yara. Yana da alhakin kowace jiha don samar da wannan dama ga yara da matasa waɗanda suka shiga cikin shirin Medicaid har sai sun kai shekaru 21. Ƙasashen na iya zaɓar yin amfani da shi a matsayin abin kula da kulawa da yara da aka sa hannu a shirin Sashen Kula da Lafiya na yara (CHIP) . Wasu jihohi, duk da haka, suna amfani da tsari daban-daban na shirin CHIP.
Abin da Kuna Bukatar Sanin CMS Form 416
{Asashen suna bayar da rahoto game da ha] in gwiwa da kuma biyan ku] a] e da EPSDT ta hanyar kammala wata takarda da ake kira CMS Form 416 a kowace shekara.
Wannan tsari ya rushe yawan mutanen Medicaid zuwa kungiyoyi daban-daban daban sannan ya tambayi nawa daga cikin wadannan yara ya karbi takaddama ko magani a wancan shekarar.
Kwayar CMS 416 ta ba da damar gwamnatin tarayya ta lura da yadda kowane jiha ke gudana. Ana iya amfani da bayanin don ganin inda (ko kuma idan) jihohi suna fadowa baya kuma zai iya zama dama don jagorantar su zuwa ga ingantawa wajen samar da kulawa mai mahimmanci.
Matsalar ita ce an tattara bayanai amma ba a amfani dasu ba.
Lokacin da jihohi ba su cika CMS Form 416 ko kuma lokacin da suka kasa shiga gamayyar EPSDT, ba a magance su ba ta Cibiyoyin Kula da Medicare da Medicaid Services (CMS).
Ingantaccen EPSDT ya zo ne ba saboda gwamnatin tarayya ta aiwatar da dokokinta ba. Inganta ya zo ne saboda mutane sun tsaya kan kansu. An gabatar da shari'un kundin tsarin aiki a kan jihohi daban-daban don buƙatar kulawar da aka yi musu. Duk da yake yankunan EPSDT sun ragu, kulawa na hakori, gyaran gubar, da kuma ayyukan kiwon lafiya na tunanin mutum ne inda aka dauki mataki mafi doka.
A ina EPSDT ya ɓace a kula da hakori
Kyau mai kyau yana da muhimmanci ga ci gaba da gina jiki mai kyau da kuma jin daɗin rayuwa. Abin takaici, ƙananan ƙwayar ƙwayoyi ne ɗaya daga cikin batutuwa da suka shafi rayuwar yara.
A shekarar 2014, kashi 48 cikin 100 na yara masu magani a Medicaid sun sami kulawa na hakori da kuma lokacin da aka gano matsala, kashi 22 kawai ne kawai aka samu magani don wannan yanayin.
Ko da lokacin da ka dubi mafi kyawun mafi kyau, tare da jihohi da jihohi na Columbia, jihohin 13 kawai-Arkansas, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Maryland, Massachusetts, Nebraska, South Carolina, Texas, Vermont, da Birnin Washington-da aka yi a kashi 51 zuwa 62 cikin dari na yawan ku] a] en da ake amfani da su don cin hanci.
Idan yazo da magani, lambobin ba su da ban sha'awa sosai. Kasashen da ke gudana daga cikin kashi 25 zuwa 52, sun hada da Arkansas, Colorado, Connecticut, Idaho, Massachusetts, Mississippi, New Jersey, New Mexico, Oklahoma, Texas, Virginia, Washington, da West Virginia.
A ina EPSDT ya ɓace a cikin dubawa
Bayyanawa don jagoranci zai iya haifar da mummunan sakamako na lafiya daga jima'i zuwa yanayin halayyar jiki da kuma rashin lafiya. EPSDT na buƙatar cewa an shigar da yara a Medicaid don jagorancin jini a watanni 12 da watanni 24.
Abin baƙin cikin shine, bayan da kudade na tarayya don Cibiyar Kula da Cututtuka na Cututtuka da Rigakafin Cibiyar Kula da Cututtuka da Rigakafin ya kare a shekara ta 2012, kananan jihohin sun ba da bayanai ga gwamnati.
Bayanan maganin Medicaid na shekara ta 2015 ya nuna cewa kashi 38 cikin dari na yara ne kawai aka yi wa aikin kula da jini kamar yadda umurnin EPSDT ya buƙaci.
Kwamitin Kasuwanci na Gaskiya na Gaskiya (NCQA), kungiyar ba da riba, an fitar da bayanan da aka kiyasta cewa kawai kashi 66 cikin 100 na yara masu shekaru 2 da aka sanya su a cikin Medicaid sun kasance masu kula da matakan jagoranci a cikin shekaru 2 da suka gabata.
Inda EPSDT ya ɓace a ayyukan kiwon lafiya na tunanin mutum
Da zarar yaro tsakanin shekara 6 zuwa 20 yana da asibiti don rashin lafiya ta jiki, samun ci gaba da ci gaba da halayyar mutum da kuma kula da lafiyar jiki. EPSDT na buƙatar cewa waɗannan yara za su gani a biye a cikin kwanaki 7 na asibiti.
A shekara ta 2014, a matsakaici, kawai kashi 44 cikin dari na yara an gani ne a cikin kwanaki bakwai da kashi 65 cikin dari cikin kwanaki 30 na asibiti don rashin lafiya.
Kasashen da ke aiki a saman kundin don biyan kwana 7 a cikin 62 zuwa 76 bisa dari sun hada da Iowa, Kansas, Maine, Massachusetts, Nevada, New York, Oregon, Rhode Island, da kuma Vermont, amma idan ya zo ga 30 -day follow-up, swap fitar da Iowa na Indiana. Ƙungiya ta ƙarshe ta yi a 78 zuwa 91 bisa dari.
Magunguna da yawa, musamman ma masu tasowa, da ake amfani dasu don magance matsalar rashin lafiyar jiki suna da tasiri. EPSDT yana buƙatar yaran yara sunada waɗannan magunguna a cikin kwanaki 30 na fara magani (Farawa na farko) kuma ana ganin su sau biyu a cikin watanni 9 masu zuwa (Ci gaba da Taron Tsare).
Domin shekara ta 2014, jihohi sun sami kashi 44 cikin dari na nasarar nasarar farawa da kuma kashi 57 cikin 100 na Tsarin Ci gaba da Taimako.
Don farawa Phase, Arkansas, Connecticut, Maine, New York, Ohio, Oklahoma, Oregon, da kuma Rhode Island, kuma Vermont yayi mafi girma a 53 zuwa 69 bisa dari yayin da Ci gaba da Maintenance Phase ya kai gagarumar nasara daga 63 zuwa 84 bisa dari a Arkansas , Connecticut, Maine, New York, Ohio, Rhode Island, Vermont, da West Virginia.
Future of Medicaid
EPSDT an riga an gwagwarmaya. {Asashen suna gaza da samar da yara masu kulawa da yara daga cikin iyalan da ba su da ku] a] en da kuma bukatunsu, kuma gwamnatin tarayya ta daina yin aiki.
Da alama wannan yanayin ba shi yiwuwa ya inganta kowane lokaci nan da nan.
Kwamitin Jirgin yana da kudade na tarayya don Medicaid a cikin gininsa. Dokar Amincewa da Lafiya ta Amirka , kamar yadda aka sanya shi a cikin wakilai na Amirka, zai rage yawan ku] a] en na tarayya ga Medicaid da dala biliyan 800 a kan shekaru 10, da tasiri ga ikon jihar ba kawai don samar da amfanin EPSDT amma amfanin Medicaid a manyan. Kodayake wannan doka, wanda ake kira Dokar Sakamakon Kula da Kulawa tagari, ta kasa yin zabe a Majalisar Dattijai, ya kafa wata mahimmanci don karewa Medicaid. Wata doka za a iya ba da shawara a wurinsa.
Wannan ya bar Amirkawa su yi wa kansu kansu. Hukuncin kundin tsarin aiki sun tilasta hannun jihohi su yi abin da ke daidai. Ga wasu daga cikin manyan shari'ar da suka shiga cikin wasanni a cikin 'yan shekarun nan.
- Emily Q vs. Bonta (California)
- Florida Fediatric Society / The Florida Chapter of the American Academy of Pediatrics v. Levine (Florida)
- GD vs. Riley (Ohio)
- NB vs. Norwood (Illinois)
- Salazar da District of Columbia (District of Columbia)
Tare da kudade na Medicaid a hadari, sa ran ƙarin ƙaddarar aikin kundin tsarin aiki a nan gaba.
Kalma Daga
Gwamnatin tarayya ta kafa dokar ta EPSDT don tabbatar da cewa yara a Medicaid sun sami mahimmanci, kulawa mai kyau. Duk da haka, an yi kadan ne don tabbatar da cewa jihohi sun cika alkawarin. Idan an hana yaronka a karkashin maganin Medicaid, kawo wannan a hankali ga Ma'aikatar Lafiya ta jiharka. Idan har yanzu kun ci gaba da gano matsaloli, zai iya zama mafi kyau ga ku gani idan akwai kundin tsarin aiki a jiharku don magance matsalar.
> Sources:
> Rahotanni na shekara ta 2015 game da kulawa da yara ga Medicaid da CHIP . Yanar gizo Medicaid. https://www.medicaid.gov/medicaid/quality-of-care/downloads/2015-child-chart-pack.pdf. An buga Agusta 2016.
> Mahimmanci na gwajin gwagwarmayar jini don yara Yayinda aka sanya su a cikin Medicaid da kuma Shirin Kula da Lafiya na Yara. Yanar gizo na Medicaid.gov. https://www.medicaid.gov/federal-policy-guidance/downloads/cib113016.pdf.
> Shirye-shiryen Farko da Tsarin Alkawari, Ciki da Kulawa da Jiha. Cibiyar yanar gizo ta Ilmantarwa da Cibiyar Ilimi. https://eclkc.ohs.acf.hhs.gov/hslc/states/epsdt. Updated Afrilu 19, 2017.
> Raymond J, Brown MJ. Tsarin jini a cikin yara Yayi <5 Years & Mdash United State, 2007-2013. Rashin ƙuntatawa da Mutuwa na Bayani (Weekly Report) (MMWR). Oktoba 2016, 63 (55); 66-72. Doi: https://www.cdc.gov/mmwr/volumes/63/wr/mm6355a6.htm.
> Amfani da Dental Services a Medicaid da CHIP . Yanar gizo Medicaid. https://www.medicaid.gov/medicaid/benefits/downloads/secretarys-report-dental-excerpt.pdf. An buga Janairu 2015.