Zvashandiswa chikuru kugutsikana

Tsigira CHAD
Policy Priorities

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CHAD inonyatso tevera mitemo nekuvandudzwa kwemitemo, shanduko uye nyaya kumatunhu ese enyika nematunhu uye inoshanda nevakuru vehurumende nevehurumende kuona kuti nzvimbo dzehutano nevarwere vadzo vanomiririrwa muhurongwa hwese hwemitemo nehurongwa.

Pakati peiyo FQHC inokoshesa kuchengetedza kuchengetedza kuwana hutano hwemhando yepamusoro kune vese Dakotans, kunyanya vekumaruwa, vasina inshuwarisi uye vasina kuchengetedzwa. Chimwe chinhu chakakosha kuve nechokwadi chekuvharirwa kwehutano kune vese kukurudzira nharaunda dzine hutano uye kuchengetedza mashandiro ese uye kukura kwenzvimbo dzehutano mhiri kweDakotas.

Federal Advocacy

Mitemo nekugadzirisa mitemo padanho remubatanidzwa zvinokanganisa zvakanyanya masangano ehutano ane hunyanzvi (FQHCs), kunyanya munzvimbo dzemari nekuvandudza zvirongwa. Ndicho chikonzero chikwata cheCHAD chemitemo chichishanda pamwe chete nenhengo dzayo dzehutano uye vabatsiri vehutano muDakotas yose kuti vagadzire zvinonyanya kukosha uye kuendesa izvo zvakakosha kuvatungamiri vekongiresi nevashandi vavo. CHAD inobatanidza nguva nenguva nenhengo dzekongiresi uye mahofisi avo kuti varambe vachiudzwa nezvenyaya dzine chekuita neFQHCs nevarwere vavo uye kuvakurudzira kutora matanho pamitemo yakakosha yehutano uye marongero.

Federal Policy Priorities

Nzvimbo dzehutano dzenharaunda dzeDakotas neSouth Dakota Urban Indian Health dzakapa rubatsiro rwekutanga, hutano hwehutano, uye kuchengetedza mazino kune vanopfuura 136,000 veDakota muna 2021. Vakaratidza kuti nharaunda dzinogona kuvandudza hutano, kuderedza kusaenzana kwehutano, kuchengetedza mutero, uye kugadzirisa zvinobudirira matambudziko mazhinji ehutano hweveruzhinji anodhura uye akakosha, anosanganisira denda refuruu neconavirus, HIV/AIDS, kusagadzikana kwekushandisa zvinodhaka, kufa kwemadzimai, kuwana kwevakarwa hondo, uye njodzi dzinongoitika dzoga. 

Kuti vaenderere mberi nebasa ravo rakakosha uye chinangwa, nzvimbo dzehutano dzinoda kuwedzerwa kwemishonga kune varwere vasina kuchengetedzwa, rutsigiro rwenzvimbo dzehutano 'telehealth services, investimendi muvashandi, uye yakasimba uye yakagadzikana mari. Nzvimbo dzehutano dzinoda kuramba dzichishanda pamwe neCongress kugadzirisa nyaya dzinotevera. 

Kuwedzera Pharmacy Access yeVarwere Vasingashandiswe

Kupa mukana kune huwandu hwakazara hweasingadhuri, akazara masevhisi, anosanganisira emishonga masevhisi, chinhu chakakosha chemuenzaniso wenharaunda yehutano. Mari yakachengetwa kubva muchirongwa che340B inofanirwa kudzoserwa mumabasa epachipatara chehutano uye yakakosha mukukwanisa kwenzvimbo dzehutano kuchengetedza mabasa anoramba achiitwa. Muchokwadi, nzvimbo zhinji dzehutano dzinoshuma kuti nekuda kwemaitiro madiki ekushanda, pasina kuchengetwa kubva kuchirongwa che340B, vangave vakaganhurirwa zvakanyanya mukukwanisa kwavo kutsigira mazhinji emabasa avo epakati uye mabasa evarwere vavo. 

  • Zvijekese pachena kuti 340B masangano akavharirwa ane kodzero yekutenga vese vanogadzira zvinodhaka 'vakavharirwa kunze kwemishonga pamitengo ye340B yevarwere vanokodzera kuburikidza neiyo yega yega inovharirwa makondirakiti pharmacies. 
  • Cosponsor iyo PROTECT 340B Act (HR 4390), kubva kuReps. David McKinley (R-WV) naAbigail Spanberger (D-VA) kuti vadzivise vatungamiri vemishonga inobatsira (PBMs) neveinishuwarenzi kuti vasapinda mune rusaruro chibvumirano chebvumirano kana "pick-pocketing" 340B kuchengetedza kubva kunzvimbo dzehutano. 

Wedzera CHC Telehealth Mikana

Nzvimbo dzese dzehutano dzenharaunda muDakotas dziri kushandisa telehealth kusangana nevarwere vavo. Telehealth masevhisi anobatsira kugadzirisa denda, geographic, hupfumi, zvekufambisa, uye mitauro zvipingamupinyi pakuwanikwa kwehutano. Nekuti maCHC anodiwa kuti ape masevhisi akazara munzvimbo dzinodiwa zvakanyanya, kusanganisira nzvimbo dzekumaruwa dzine vanhu vashoma, nzvimbo dzehutano dziri kutanga kushandiswa kwenharembozha kuwedzera kuwaniswa kwehutano hwehutano hwehutano.  

  • Tsigira kuedza kwemutemo uye kudzora kuyedza kwekuwedzera kwehutano hweveruzhinji emergency (PHE) telehealth flexibilities, zvakanaka kuburikidza nekuchinja zvachose mutemo kana angangoita makore maviri kupa chokwadi chenzvimbo dzehutano. 

  • Tsigiro yeCONNECT yeHealth Act (HR 2903/S. 1512) uye Kudzivirira Kuwanikwa kwePost-COVID-19 Telehealth Act (HR 366). Aya mabhiri anovandudza chirongwa cheMedicare nekuona nzvimbo dzehutano se "nzvimbo dziri kure" uye kubvisa "nzvimbo dzekutanga" zvirambidzo, zvichibvumira kufukidzwa kwenhare pese pane murwere kana mupi. Aya mabhiri zvakare anobvumira masevhisi enhare kudzoserwa zvakaenzana pakushanya mu-munhu. 

Vashandi

Nzvimbo dzehutano dzenharaunda dzinoenderana netiweki yevanopfuura 255,000 varapi, vanopa, uye vashandi kuti vaunze pavimbiso yehutano husingadhuri uye hunowanikwa. Kudyara mari kwenguva refu muvashandi verudzi rwekutanga vanodiwa kuti vakwanise kuchengetedza mari inodiwa nenyika uye kuona kuti nzvimbo dzehutano dzinogona kufambirana nekukura nekushanduka kwezvinodiwa zvehutano munharaunda dzavanogara. Kushomeka kwevashandi kwakanyanya uye kukura kwemuhoro kunoita kuti zviome kuti nzvimbo dzehutano dzitore uye kuchengetedza vashandi vakabatanidzwa, vane hunyanzvi hwekuita kuti vape hutano hwemhando yepamusoro. Iyo National Health Service Corps (NHSC) uye zvimwe zvirongwa zvehurumende zvevashandi zvakakosha pakukwanisa kwedu kutora vanopa rubatsiro kunharaunda dzinovada. Tinotenda mari yakapihwa muAmerican Rescue Plan Act kugadzirisa kushomeka kwevashandi kunokonzerwa nedenda. Kuenderera mberi kwekudyara kwemubatanidzwa kwakakosha mukuwedzera vashandi mapaipi ehutano nzvimbo dzinoenderana nekupa rubatsiro kuvarwere.  

  • tsigira $2 bhiriyoni yeNHSC uye $500 miriyoni yeNurse Corps Chikwereti chekudzorera Chirongwa. 
  • tsigira FY22 yakasimba uye FY23 mari yekugovera mari yezvirongwa zvese zvekutanga zvevashandi, kusanganisira iyo Title VII Health Professions uye Title VIII Nursing Workforce Development zvirongwa. 

Tsigira Community Health Centers

Isu tinoonga mari yeAmerican Rescue Plan Act yakagoverwa kunzvimbo dzehutano kupindura kuCCIDID-19 uye imwe mari yevashandi vekutanga kuchengetedza uye kugovera vaccine. Denda reCCIDID-19 rakaratidza kusaenzana kwehutano hwehutano kunharaunda dzedu dzekumaruwa, vashoma, veteran, vakuru, uye vasina pekugara. Ikozvino kupfuura nakare kose, nzvimbo dzehutano dzave dzakakosha vatori vechikamu muhurongwa hwehutano hweveruzhinji - vachipa hutano hunodiwa hwekutanga uye hutsika panguva yedenda repasi rose. Muna 2022, tiri kutarisa kuCongress kuchengetedza hwaro mari yeCHCs uye kuisa mari mukukura kwechirongwa ichi. 

  • Tsigira inosvika mabhiriyoni maviri emadhora muHealth Center Capital Funding yekuchinjana, kugadziridza, kugadzirisa, kuwedzera, kuvaka, uye mamwe mari yekuvandudza mari kuitira kuti nzvimbo dzehutano dzirambe dzichizadzisa zvinodiwa zvehutano zvevarwere vari kukura uye nharaunda dzavanoshandira.

Kuchengetedza Kugona Kwevashandi Vezvoutano Vanozvipira Kushanda paCommunity Health Centers

Vashandi vezvehutano vanozvipira (VHPs) vanopa rubatsiro rwakakosha rwevashandi kunzvimbo dzehutano munharaunda nevarwere vavo. Iyo Federal Tort Claims Act (FTCA) parizvino inopa huipi hwekurapa kune ava vanozvipira. Nekudaro, dziviriro iyi inopera muna Gumiguru 1, 2022. Kushomeka kwakanyanya kwevashandi vekutanga uye panguva yeCOVID-19 denda rinoratidza kukurumidza kwakakosha kwevanozvipira vekurapa vasingabhadharwe kuti varambe vachidzivirirwa neFTCA.  

  • Kuwedzera zvachose iyo Federal Torts Claim Act (FTCA) kufukidzwa kwenzvimbo yehutano yenharaunda VHPs. The Kuwedzerwa parizvino kwakabatanidzwa mubipartisan Senate RUBATSIRO nhaurirano dhizaini yeGadzirira uye Kupindura kune Mavhairasi Aripo, Arikubuda Kutyisidzira Kutsva (PREVENT) Pandemics Act.  

Resources

North Dakota Advocacy

Kutsigira basa uye chinangwa chenzvimbo dzehutano munharaunda uye kuchengetedza kuwana rubatsiro rwehutano kune vese vekuNorth Dakotans nheyo dziri pakati peCHAD's advocacy edu. Chikwata chedu chinoshanda pamwe chete nenhengo dzenzvimbo dzehutano uye vabatsiri vehutano muNorth Dakota yese kutarisa mutemo, kugadzira zvinokosheswa, uye kubata vamiriri vemitemo nevamwe vakuru vematunhu nevenzvimbo. CHAD yakazvipira kuona kuti maCHC nevarwere vavo vanomiririrwa mukati mehurongwa hwese.

North Dakota Policy Priorities

North Dakota paramende inosangana makore maviri ese muBismarck. Munguva yechikamu chemutemo cha2023, CHAD iri kushanda kusimudzira zvinokosheswa munzvimbo dzehutano munharaunda nevarwere vavo. Izvo zvinonyanya kukosha zvinosanganisira kutsigira Medicaid kubhadhara shanduko, mari yenyika yeCHCs, uye kuwedzera mabhenefiti emazino, vashandi vehutano munharaunda, uye mari yekuchengeta vana.

Medicaid Payment Reform

North Dakota Medicaid uye nzvimbo dzehutano munharaunda (CHCs) dzine chinangwa chakagoverana chekuvandudza hutano hwehutano kune vanobatsirwa neMedicaid. Tinoda muenzaniso wekubhadhara unotsigira nzira yekutarisira yakaratidza kuvandudza hutano uye kuderedza mari yose. CHCs iri kukurudzira vemitemo kuti vagadzire iyo Medicaid yekubhadhara modhi iyo:

  • Inotsigira mhando dzemhando dzepamusoro-soro dzakaratidzwa kuvandudza mhedzisiro, kusanganisira kurongeka kwekutarisira, kukwidziridzwa kwehutano, rubatsiro nekuchinja kwekutarisira, uye kuongororwa kwehuwandu hwehuwandu hwehuwandu hwehuwandu hwekuita hukuru hwekutumira kune inodiwa masevhisi emunharaunda;
  • Inobatanidza humbowo-hwakavakirwa nhanho dzemhando uye inopa mari yekukurudzira kune vanopa kana mhando uye mashandisiro zvinangwa zvasangana;
  • Inopindirana nemhando dziripo dzekugadzirisa mubhadharo senge murwere-centered medical home (PCMH) uye Blue Cross Blue Shield yeNorth Dakota's BlueAlliance chirongwa; uye,
  • Inobvisa iyo inopesana nechero chikamu chekutanga chekuchengetedza kesi manejimendi chirongwa chinotungamira kuMedicaid kuramba inodiwa (uye yakakwirira-kukosha) mabasa ekutanga ekuchengetedza. Medicaid ikozvino kuramba kubhadhara mabasa ekutanga ekuchengetedza apo murwere anoona mupi uyo Medicaid asina kugadza semupi wavo wekutanga wekuchengetedza (PCP) inotungamirira kune zvisingakoshi kushanya kwekamuri yekukurumidzira uye kurasikirwa kukuru kwemari yeCHC uye vamwe vanoedza kushandira varwere munharaunda.

Dental

Nzvimbo dzehutano dzenharaunda dzinopa hutano hwakakwana kune varwere mhiri kweNorth Dakota, kusanganisira kuchengetwa kwemazino. Humbowo hunobatanidza muromo une hutano nemuviri une hutano. Semuenzaniso, chidzidzo che2017 chevanhu vane chirwere cheshuga chinoratidza kuti mari yekurapa i $ 1,799 yakaderera kune varwere vakagamuchira hutano hwakakodzera hwemuromo pane avo vasina. Kusavharwa kwemazino kwakakwana kunogona kukonzera kumwe kushanyirwa mukamuri rekukurumidzira, izvo zvinogona kukanganisa kukwira kweropa, kudzora chirwere cheshuga, uye hutano hwekufema.

  • Wedzera mabhenefiti emazino kune VOSE North Dakota Medicaid vanogamuchira, kusanganisira vanhu vanofukidzwa nekuwedzera kweMedicaid.

State Investment muCommunity Health Centers

Nzvimbo dzehutano dzenharaunda (CHCs) muNorth Dakota dzinoita basa rakakosha muhurongwa hwekuchengetedza hutano hwehurumende hunobatsira varwere vanopfuura zviuru makumi matatu nematanhatu pagore. Nyika makumi maviri nepfumbamwe pari zvino dzakakodzera zviwanikwa zvehurumende kuCHCs kuti dzitsigire basa radzo rekupa rubatsiro kune vanhu vasina kuchengetedzwa uye vanotambura. North Dakota CHCs inoda kuwedzerwa kune iyi runyorwa.

Tinokukumbirai kuti mufunge kugovera madhora miriyoni maviri muzviwanikwa zvehurumende kumaCHCs kuti atsigire uye akure kugona kwavo kushandira vanhu vanotambura uye vasina kuchengetedzwa zvakanaka mudunhu. Vaizoshandisa zviwanikwa kuzadzisa zvinangwa zvinotevera:

  • Deredza kushanya kwekamuri rekukurumidzira uye kuchipatara kune vanobatsirwa neMedicaid uye vasina kuchengetedzwa;
  • Chengetedza rubatsiro runodiwa munharaunda kune avo vanotambura zvakanyanya;
  • Pindura kumatambudziko evashandi uye kushomeka;
  • Ita hutano IT investments inotsigira kuvandudzwa kwehutano; uye,
  • Kunda zvipingamupinyi kune hutano munharaunda dzisina kuchengetedzwa kuti utsigire kuwanikwa kwekudya kune hutano uye dzimba dzinodhura, kuchengetedza kuparidzira, kushandura, chekufambisa, uye mamwe mabasa asingabhadharwe.

Community Health Workers

Vashandi vezvehutano munharaunda (CHWs) vakadzidziswa kumberi kwevashandi vezvehutano vane hukama hwemagariro uye hwehukama kunharaunda dzavanoshandira, vanoshanda sekuwedzera kwenharaunda kwemabasa ezvehutano. MaCHWs anogona kuwedzera kuwaniswa kwehutano kuNorth Dakota, kuderedza mitengo yehutano, nekuvandudza hutano hweNorth Dakotas. Kana yabatanidzwa nehutano hwekutanga, maCHWs anogona kuwedzera kutarisirwa kwechikwata, kunoenderana nemurwere nekuwedzera basa renyanzvi dzehutano. MaCHW anobatsira vachengeti vekutanga kunzwisisa matambudziko chaiwo anosanganikwa nawo nevatengi zuva nezuva. Vanogona kubatsira kuvaka kuvimbana pakati pevarwere nemapoka avo ehutano kugadzirisa matambudziko uye kuona maitiro ekuita zvirongwa zvavo zvekuchengetedza kiriniki.

Sezvo masisitimu ehutano achishanda pamazano ekuvandudza hutano, kuderedza mari yehutano, uye kuderedza kusaenzana kwehutano, North Dakota inogona kufunga nezvekuita mitemo yekumisa zvirongwa zveCHW zvinogara zvakadaro.

  • Gadzirai zvivakwa zvinotsigira zvirongwa zveCHW, zvinogadzirisa kuzivikanwa kwenyanzvi, dzidzo nekudzidziswa, mirau, uye muripo werubatsiro rwekurapa.

Chengetedza Mukuchengeta Kwevana Kuti Upe Kusvikika, Kwemhando yepamusoro, uye Kunodhura Kuchengeta

Kuchengeta vana, chokwadi, chikamu chakakosha chehupfumi huri kusimukira. Kuwana kuchengetwa kwevana kunokwanisika kwakakosha kuti vabereki varambe vari pabasa uye chinhu chakakosha chekutora vashandi kunharaunda dzedu. Paavhareji, mhuri dzinoshanda muNorth Dakota dzinoshandisa 13% yebhajeti remhuri yavo mukuchengeta vana vacheche. Panguva imwecheteyo, mabhizinesi ekuchengeta vana anonetsekana kuti arambe akavhurika, uye vashandi vanochengeta vana vanowana madhora zviuru makumi maviri nezvina nemazana mashanu kana vachishanda nguva yakazara, vasingaregi pamusoro pehurombo hwemhuri yevatatu.

  • Tsigira mubhadharo wakawedzerwa wevashandi vanochengeta vana, gadzirisa mirau yekuwana mari kuti upe mhuri dzakawanda rubatsiro rwekuchengeta vana, kuwedzera rubatsiro rwekudzikamisa kuchengetwa kwevana, uye kuwedzera Musoro Kutanga uye Early Head Start zvirongwa.

Resources

South Dakota Advocacy

Kutsigira basa uye basa renzvimbo dzehutano uye kuchengetedza kuwanikwa kwehutano kune vese veSouth Dakotans nheyo dziri pakati peCHAD's advocacy efforts. Chikwata chedu chinoshanda pamwe chete nenhengo dzenzvimbo dzehutano uye vabatsiri vehutano muSouth Dakota yese kutarisa mutemo, kugadzira zvinokosheswa, uye kubata vamiriri vemitemo nevamwe vakuru vematunhu nevenzvimbo. CHAD yakazvipira kuona kuti nzvimbo dzehutano nevarwere vavo vanomiririrwa mukati mehurongwa hwese.

South Dakota Policy Priorities

South Dakota paramende inosangana gore negore muPierre. The 2023 chikamu chemutemo akatanga musi waJanuary 10, 2023. Munguva yechikamu, CHAD ichaongorora  nezveutano-mutemo wakabatana apo tsigirara uye kusimudzirara china zvinokosheswa nepolicy:

Vashandi - Kuvandudza uye Kutorwa kweVashandi Vehutano

Mhinduro dzevashandi vehutano munharaunda dzekumaruwa dzinoramba dzichida imwe mari. Imwe inovimbisa chirongwa iState Loan Repayment Program. Chirongwa ichi chinobvumira nyika kumisikidza zvinokosheswa munharaunda yekubhadhara chikwereti kune vashandi vehutano vanoshanda munzvimbo dzinoshomeka dzehutano. Tinotenda kuti Dhipatimendi rehutano reSouth Dakota nguva pfupi yadarika rakatora mukana wemari iyi kutsigira kutorwa kwevashandi vehutano.

Isu tinoziva kuti kudiwa kwerudzi urwu rwechirongwa kwakakwira, uye isu tingakurudzire rumwe rutsigiro rwezvirongwa izvi kuti zvizadzise kudiwa ikoko. Dzimwe mhinduro dzinosanganisira kusimbaradza zvirongwa zvepaipi yevashandi vehutano huripo, kuisa mari mukugadzira zvirongwa zvitsva zvepombi, uye kuwedzera mari muzvirongwa zvekudzidzisa.

Workforce – Optimal Team Practice Legislation

Nzvimbo dzehutano dzenharaunda uye South Dakota Urban Indian Health inotsamira pahunyanzvi uye hunyanzvi hwevabatsiri vevanachiremba (PAs) uye vamwe vanopa maitiro epamusoro kuti vazadzise zvinodiwa nenharaunda dzekumaruwa nemumaguta dzavanoshandira. Iko kushanduka kwemaitiro ekurapa kunoda kuchinjika mukuumbwa kwezvikwata kuti zvizadzise zvinodikanwa zvakasiyana zvevarwere. Nzira iyo maPAs nevarapi vanoita pamwe chete haifanirwe kutariswa padanho remutemo kana rekutonga. Pane kudaro, kutsunga ikoko kunofanira kuitwa netsika mukunakira varwere nenharaunda dzavanoshandira. Zvazvino zvinodikanwa zvinodzikisira kuchinjika kwechikwata uye kudzikisira kuwana kwemurwere mukutarisirwa pasina kuvandudza kuchengetedzwa kwemurwere.

340b Dzivirira Kuwanika kune Inodhura Mishonga kuburikidza ne340b Chirongwa

Nzvimbo dzehutano dzenharaunda neSouth Dakota Urban Indian Health dziri kushanda kuti dzipe huwandu hwakazara hwehutano hunodhura, kusanganisira pharmacy. Chimwe chishandiso chatinoshandisa kushandira iyo mission chirongwa che340B chemitengo yezvinodhaka. Chirongwa ichi chakavambwa muna 1992 kuti chipe mitengo inokwanisika kuvarwere vanopihwa nevekumaruwa nekuchengetedza mambure.

Nzvimbo dzehutano dzinoratidza rudzi rwekuchengetedza mambure chirongwa chirongwa che340B chaiitirwa kutsigira. Nemutemo, nzvimbo dzese dzehutano:

  • Shandira nzvimbo dzinoshomeka dzehutano chete;
  • Ita shuwa kuti varwere vese vanokwanisa kuwana huwandu hwakazara hwesevhisi yavanopa, zvisinei nemamiriro einishuwarenzi, mari, kana kugona kubhadhara; uye,
  • Vanosungirwa kudzoreredza mari yese 340B yakachengetwa muzviitiko zvakatenderwa nemubatanidzwa kuti vafambise basa ravo rekupa rekuona mukana wekuchengeta vasina kuchengetedzwa.

Tiri kukumbira Hurumende kuti ichengetedze chirongwa chakakosha ichi chinopa varwere vese vemuzvipatara mukana wekuwana mishonga inodhura. Vagadziri vakasiyana-siyana vakatyisidzira kurasikirwa nekuderedzwa kwezvinodhaka kumishonga inotumirwa kumakondirakiti emishonga iyo inopa 340B mishonga pachinzvimbo chevamwe vanopa zvakanyanya munyika yedu. Uku kutariswa kwemishonga yemakondirakiti kuri kunyanya kunetsa munharaunda dzekumaruwa, uko mafemasi emuno ari kutonetsekana kuti arambe achifamba.

Medicaid Kuwedzera Implementation

MuSouth Dakota, Medicaid ichawedzera purogiramu muna July 2023. Dzimwe nyika dzakawedzera chirongwa chavo cheMedicaid vakaona kuvandudzwa kwekuwana rubatsiro, kuvandudzwa kwehutano hwehutano, uye kuderedza kusingabhadharwi kusingabhadharwi, izvo zvinoita kuti hutano hwehutano huve huri nyore kune wese.

Kuti ive nechokwadi chekuita kwekuwedzera kweSouth Dakota Medicaid kunoshanda, tinokumbira kuti muise pamberi neDhipatimendi reSocial Services mazano aya:

  • Gadzira Medicaid Expansion Advisory Committee, kana komiti-diki yeMedicaid Advisory Committee, kufambisa nekusimudzira kutaurirana nevapi, hurongwa hwehutano, uye varwere izvo zvinozokanganisa;
  • Tsigira chikumbiro chebhajeti raGavhuna Noem chekuwedzera vashandi uye tekinoroji muchirongwa cheMedicaid; uye,
  • Ipa mari kumasangano ari izwi rinovimbwa muhutano hwehutano munharaunda uye hutano inishuwarenzi yehutano kuti aite zvakananga kuparidzira kune vatsva veMedicaid.

Resources