1. Yam kev pab twg kuv tuaj yeem tau txais los ntawm Medi-Cal1 raws li EPSDT?

EPSDT yog sau los ntawm Kev Tshuaj Xyuas, Ntsuas Mob thiab Kho Mob Thaum Ntxov thiab Raws Caij Nyoog.  EPSDT yog Medi-Cal qhov nyiaj pab. Yog tias koj yog tus neeg muaj hnub nyoog qis dua 21 xyoo thiab muaj txhua cov kev pab Medi-Cal,2 koj tau txais qhov EPSDT nyiaj pab.3

EPSDT muab ntau cov nyiaj pab ntawm kev kho mob rau koj. 

Kev tshuaj xyuas raws caij nyoog—Ua ntej tshaj, EPSDT hais tias Medi-Cal yuav tsum muab cov kev tshuaj xyuas mob raws caij nyoog txhawm rau txiav txim siab txog yam kev kho mob uas koj xav tau.  Qhov no suav nrog kev tshuaj xyuas qhov hnov lus, qhov pom kev, kaus hniav thiab tshuaj xyuas kev mob hlwb.  Nws kuj tseem suav nrog kev tshuaj xyuas txog cov kuab lom hauv lub cev.

Kev pab tshuaj xyuas mob thiab kev kho mob—Qhov thib ob, thaum koj muaj ib tus mob uas yuav tsum tau kho, EPSDT hais kom Medi-Cal yuav tsum muab cov kev pab tshuaj xyuas mob thiab kev kho mob kom “Raug lossis hloov kho tshiab” rau koj tus mob.

Txhua qhov kev pab kho mob uas tuaj yeem tau txais kev them rau qhov kev pab Medicaid—EPSDT muab rau ntau cov kev kho mob, suav nrog cov kev pab uas tsis yog cov npe ntawm cov kev pab Medi-Cal uas ib txwm muaj rau cov neeg muaj hnub nyoog 21 xyoo thiab laus dua. Qhov no vim tias California tuaj yeem xaiv kom txwv cov kev pab uas nws muab rau cov neeg loj, tab sis muab rau cov menyuam yaus hnub nyoog qis dua 21 xyoo, Lub Xeev yuav tsum muab ib co kev pab uas Medicaid qhov kev pab tuaj yeem them rau, txawm tias yog Lub Xeev tau xaiv tsis muab cov kev pab rau cov neeg loj los xij.

Cov piv txwv suav nrog cov kev pab ntxiv kho hniav, kho qhov muag, kho qhov hnov lus, kev pab cuam kev ua haujlwm ntawm tus kheej (zeeg kws saib xyuas neeg mob) los ntawm Cov Kws Rau Npe Saib Xyuas Neeg Mob (RN) lossis Cov Kws Tso Cai Saib Xyuas Neeg Mob (LVN), Cov Tuav Tswj Kho Mob, Cov Kws Kho Mob Menyuam Yaus Nruab Hnub, Kev Ntsuas thiab Cov Kev Pab Saib Xyuas Khoom Noj Haus Zoo, Cov Kev Ntsuas thiab Kev Pab Cuam Kho Mob Hlwb.  Cov kev ntsuas thiab pab cuam kho mob hlwb suav nrog cov kev pab kho coj tus cwj pwm (TBS), thiab cov kev pab kho coj tus cwj pwm hauv tsev (IHBS), thiab cov kev pab dhia haujlwm kho mob (ICC).4

2. Qhov kev pab EPSDT thiab Medi-Cal sib txawv li cas?

EPSDT tsis txawv qhov Medi-Cal – nws yog ib feem ntawm Medi-Cal. Nws tsuas yog cov kev pab ntxiv uas koj tau txais vim yog koj muaj hnub nyoog qis dua 21 xyoos.  EPSDT muaj qhov uas muaj laj thawj, cov qauv txheej txheem uas yog kev kho mob tsim nyog rau cov tau txais kev tso cai muab kev pab. Nws txhais tau tias koj tuaj yeem tau txais kev ntsuas mob thiab kev pab ntau dua li qhov koj yuav tsum tau txais yog tias koj muaj hnub nyoog 21 lossis laus dua yog tias koj tus kws kho mob lossis cov kws tshaj lij kho mob hais kom ua. Lub Xeev yuav tsum pom zoo tias qhov kev pab yog "kev kho mob tsim nyog."

3. Qhov EPSDT cov qauv txheej txheem kev kho mob tsim nyog yog dab tsi?

Cov kev pab raws li EPSDT yog qhov kev kho mob tsim nyog yog tias qhov kev kho mob yog ‘kev kho mob raug lossis txhim kho tshiab thiab kho tus mob lub cev thiab mob hlwb thiab muaj mob.5

4. Puas yog kuv tau txais EPSDT yog tias kuv muaj MAGI Medi-Cal?

Yog, yog tias koj muaj hnub nyoog qis dua 21 xyoo. Tsab Cai Kev Kho Mob Txaus nthuav dav tus npawb ntawm cov neeg uas tuaj yeem muaj cai txais Medi-Cal. Tau Hloov Kho Tshiab Raws Li Cov Nyiaj Khwv Tau Los Tag Nrho (MAGI) yog ib qho txheej txheem los ntawm cov muaj feem phab nyiaj txiag uas tau txiav txim rau cov pawg neeg ntxiv no, nrog rau cov nqi them se thiab cov nqi sib pab them los ntawm Covered California.6 Cov neeg uas tau txais qhov kev pab MAGI Medi-Cal tau txais tib co nyiaj pab raws li cov uas ib txwm muaj rau Medi-Cal.7

5. Yuav ua li cas yog tias kuv muaj California Cov Kev Pab Menyuam Yaus (CCS)?

CCS yog lub xeev qhov kev pab rau cov menyuam yaus muaj hnub nyoog qis dua 21 xyoo uas muaj qhov xiam oos qhab.8 Koj tuaj yeem muaj CCS thiab Medi-Cal ua ke. Koj tseem muaj cai tau txais EPSDT raws li Medi-Cal txawm tias koj muaj CCS los xij. 

6. Medi-Cal managed care yog dab tsi?

Cov neeg feem coob uas yog neeg xiam oos qhab niaj hnub no tau txais lawv cov Medi-Cal hla qhov kev npaj tuav tswj kev kho mob. Qhov kev npaj kho mob Medi-Cal managed care yog qho chaw sib koom es ntawm cov kws kho mob suav nrog tsev kho mob, cov kws kho mob, cov kws kho lub cev thiab lwm yam, uas muab cov kev pab kho mob rau nws cov tswvcuab.   Hauv qhov kev npaj kho mob Medi-Cal managed care, feem ntau koj muaj qhov txwv rau cov kws kho mob hauv qhov kev npaj kho mob.9 Koj xaiv thawj tus kws kho mob (primary care physician (PCP)) uas yuav dhia haujlwm rau koj li kev kho mob thiab xa koj mus rau cov kws kho mob tshwj xeeb yog tias xav tau.   Qhov no sib txawv qhov Fee-For Service Medi-Cal (qee zaus tau hu tias “traditional,”  “straight,” lossis “regular” Medi-Cal) uas koj tuaj yeem mus rau ib tus kws kho mob uas lees txais qhov Medi-Cal. 

7. Puas yog kuv tseem tau txais EPSD yog tias kuv tau txais Medi-Cal managed care?

Yog.  Yog tias koj tau txais Medi-Cal hla qhov kev npaj kho mob Medi-Cal managed care koj kuj tseem tau txais cov nyiaj pab EPSDT.  Koj muaj tib co cai raws li qhov koj ua thaum koj yog tus tau txais cov kev pab dawb Medi-Cal.

8. Qhov EPSDT ua haujlwm li cas thaum kuv nyob hauv Medi-Cal managed care?

Qhov kev npaj kho mob Medi-Cal managed care yuav tsum muab cov nyiaj pab EPSDT rau koj raws li lub xeev thiab tsoomfwv tsab kev cai lij choj.  Lawv yuav tsum siv EPSDT cov qauv txheej txheem kho mob tsim nyog thaum xaiv cov kev pab tau tso cai.  Qhov kev npaj kho mob Medi-Cal managed care yuav tsum muab cov kev tuav tswj kho mob muaj txiaj ntsig zoo, cov kev sib koom tes kho mob, thiab thawj cov luag haujlwm txhawm rau muab txhua cov kev pab kho mob tsim nyog txawm tias muaj lwm cov kev pab xws li cov kev pab hauv tsev kawm, cov chaw pab cuam hauv cheeb tsam, lossis lwm cov kev pab uas tuaj yeem muab cov kev pab rau.  Cov menyuam yaus tsis tas yuav tsum muaj cov kev pab uas tag ua ntej qhov kev npaj kho mob Medi-Cal managed care ua tus ua lub luag haujlwm. Muaj cov kev pab uas yog “tshem tawm” ntawm qhov kev tuav tswj kho mob thiab tsis yog qhov kev npaj kho mob Medi-Cal managed care lub luag haujlwm muab kev pab rau. Cov kev pab no suav nrog kev pab kho hniav uas pab them los ntawm qhov kev pab Denti-Cal thiab cov kev pab kho mob hlwb tshwj xeeb.10

9. Kuv tsis txaus siab nrog qhov kev txiav txim ntawm kuv qhov kev npaj tuav tswj kev kho mob, yam uas kuv tuaj yeem ua tau yog dab tsi?

Nyeem qhov laj thawj tias vim li cas cov kev pab thiaj raug tsis kam lees lossis txo qis thiab cov qauv txheej txheem kev kho mob tsim nyog ntawm koj qhov kev npaj kho mob Medi-Cal managed care tab tom siv.  Yog tias koj qhov kev npaj kho mob Medi-Cal managed care tsis qhia meej txog EPSDT hauv nws qhov laj thawj rau kev tsis kam lees, ces nws yuav siv cov qauv txheej txheem kev kho mob tsim nyog tsis raug. Yog tias koj qhov kev npaj kho mob Medi-Cal managed care hais tias “tsis tau” vim yog cov kev pab tsis pab them, uas qhia rau koj tias nws yuav tsis tau txais kev txiav txim ua qhov kev pab ntxiv uas muaj los ntawm EPSDT. 

Yog tias koj tsis txaus siab nrog koj qhov kev npaj kho mob Medi-Cal managed care qhov kev txiav txim koj tuaj yeem sau ntawv foob tsis txaus siab thiab/lossis ntawv foob.   Pib txij thaum Lub Xya Hli 1, 2017, cov cai rau kev hais qhov tsis txaus siab thiab foob tau hloov pauv. Kom paub ntau ntxiv mus saib: Txhua Tsab Ntawv Qhov Kev Npaj Kho Mob 17-006 ntawm:

http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/…; Koj kuj tseem tuaj yeem nyeem peb cov ntaub ntawv nthuav tawm hauv zaj lus no ntawm https://www.disabilityrightsca.org/publications/medi-cal-managed-care-a….

Nco tseg: yog tias koj nyob rau hauv tus nqi-rau kev pabcuam Medi-Cal, koj tuaj yeem ua ntaub ntawv rau Medi-Cal kev sib hais ncaj ncees.11

• 1. Medicaid kuj tseem paub zoo tias yog Medi-Cal hauv California.
• 2. Txhua cov kev pab Medi-Cal txhais tau tias yog txhua cov kev pab uas muaj raws li qhov Medi-Cal. Txhua cov kev pab Medi-Cal tsis suav cov neeg uas tau txais cov kev pab xwm txheej kub ntxhov Medi-Cal xwb.
• 3. 22 CCR § 51340; http://www.dhcs.ca.gov/services/Pages/EPSDT.aspx
• 4. 42 USC §1396d(r); 22 CCR §§ 51340, 51340.1, 51184; http://www.dhcs.ca.gov/services/MH/Documents/PPQA%20Pages/Katie%20A/Med…
• 5. 42 USC § 1396d(r)(5); 22 CCR §§ 51340 thiab 51340.1
• 6. Kom paub ntau ntxiv txog Covered California mus saib hauv: https://www.coveredca.com/ https://www.affordablecarecalifornia.org
• 7. Saib DRC ntaub ntawv nthuav tawm #555101 – “Yam Kev Nthuav Dav Ntawm Cov Neeg Loj/MAGI Medi-Cal yog dab tsi?” ntawm https://www.disabilityrightsca.org/publications/what-is-adult-expansion…
• 8. Saib http://www.dhcs.ca.gov/services/ccs/Pages/default.aspx
• 9. Kom paub ntau ntxiv txog Medi-Cal managed care, saib hauv DRC cov ntaub ntawv nthuav tawm # 549501, ntawm https://www.disabilityrightsca.org/publications/medi-cal-managed-care-h… thiab # 554501. Kuj tseem pom hauv - Medi-Cal Managed Care: "Txuas Ntxiv Cov Kev Kho Mob" ntawm: https://www.disabilityrightsca.org/publications/medi-cal-managed-care-c… Yog tias koj npaj txhij rau hauv qhov kev npaj tuav tswj kho mob thiab xav mus saib cov chaw kho mob tsis koom nrog mus saib hauv DRC cov ntaub ntawv nthuav tawm #555901 ntawm https://www.disabilityrightsca.org/publications/medi-cal-managed-care-o…
• 10. Saib Txhua Cov Ntawv Kev Npaj Kho Mob 14-017: Cov Yuav Tsum Tau Ua rau Cov Kev Pab Them Ua Ntej thiab Cov Ncua Sij Hawm : Kev Tshuaj Xyuas, Ntsuas thiab Kho Mob Mob rau Cov Neeg Tau Txais Medi-Cal Hnub Nyoog Qis Dua Nees Nkaum Ib Xyoos ntawm: http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/…
• 11. Txhawm rau thov Medi-Cal lub chaw saib xyuas kev ncaj ncees kom tshuaj xyuas Koj Tsab Ntawv Ceebtoom Kev Txiav Txim rau cov ntaub ntawv txog yuav thov li cas rau kev sib xyuas kev ncaj ncees thiab hnub tag sij hawm rau kev thov saib xyuas kev ncaj ncees thaib cov kev pab uas tseem tsis tau them. Koj tseem mus saib tau hauv: http://www.cdss.ca.gov/Hearing-Requests thiab http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFairHearing.aspx