Iimali zisebenzisa njani ii-Medicaid Waivers ukuze zenzele iiNkqubo zoMilicaid zazo
I-Medicaid ixhaswa ngemali kunye noburhulumente wephondo kunye noorhulumente karhulumente, ukubonelela ngoncedo kubantu ngabanye kunye neentsapho ezinomvuzo ophantsi ongenazo i-inshorensi yempilo kunye nokuba unonophelo olungakanani lwempilo luya kuba ngumthwalo omkhulu wemali. I-Medicaid ilawulwa yiphondo ngalinye, kwaye imigaqo yokufaneleka iyahluka kummandla ukuya kwimeko.
I-waiver ye-Medicaid ivumela amazwe ukuba avavanye kwaye aphuhlise iindlela ezinikela ngayo iinkqubo zeMedicaid ezixhaswa ngemali ezahlukileyo kwiprogram yomgaqo-nkqubo.
Ezi nkqubo zinokuba neemfuno ezifanelekileyo zokufaneleka, okanye iinkqubo zinokusebenza njengemibutho yokunyamekela. Ngokomzekelo, iiprogram zeMedicaid zingenziwa zenzelwe abantu abathile abanesidingo, njengabantu abadala okanye abafazi abakhulelweyo.
EUnited States, iMedicaid yinkonzo enkulu yentlalo yenkxaso-mali yonyango kunye neemfuno zononophelo zempilo yabantu abaphantsi kwemali engenayo. Nangona zonke iinjongo ziyakwamukela inkxaso-mali yeMedicaid kwaye zineenkqubo zazo zeMedicaid , ezo nkqubo ziyahluka. Ukongeza kokukwazi ukufaka isicelo sokuxhaswa kweMedicaid, iindibano zinokuthi "zikhethe" zokufumana inkxaso-mali kunye neemfuno ezintsha zeMedicaid.
Iifayile zingaphinde zisetyenziswe kwiNkqubo ye-Intshuwalense yezeMpilo (Children's Health Programme) (CHIP), ebonelela ngemali ye-federal ukufanisa iimali zelizwe ezijongene nabantwana abangaxhaswanga kunye neentsapho ezinomvuzo ophantsi kodwa ezingenakuhlangabezana neemfuneko zokufaneleka eziMilicaid.
Iingcamango zeMedicaid
Ukukhishwa kweMedicaid i-aivers ingahamba ngamagama amaninzi.
La magama aquka ukukhutshwa kwe-1115 (egunyazisiweyo yiCandelo 1115 loMthetho woKhuseleko loLuntu), i-1915 yaivers (egunyazisiweyo yiCandelo 1915 yoMthetho woKhuseleko loLuntu), iinkonzo zokuxoshwa, iinkqubo zokuxoshwa, iiNkonzo zeKhaya kunye noLuntu (Based HCBS), kunye amagama ahlukeneyo kumazwe athile.
Kukho iindidi ezininzi ze-Medicaid waivers, nangona ziwela phantsi kwegunya leCandelo 1115 no-1915 loMthetho woKhuseleko loLuntu:
- Icandelo le-1115 yokurhoxisa livumela iiprojekthi zophando kunye neeprojekthi ezilungiselelwe ukuvavanya okwaneleyo ukulungelelaniswa okanye ukhetho, kunye neendlela zokwenza imali kunye nokuhambisa iMedicaid. Icandelo le-1115 yokukhishwa ngokufanelekileyo livumela "iiprojekthi" okanye "imiboniso" iinkqubo ezilindeleke ukuba zithuthukise okanye zikhuthaze ukukhutshwa kunye nokusebenza kakuhle. Ngokunyuselwa kweMedicaid phantsi koMthetho woNonophelo olungabonakaliyo, ii-1115 zaiver ziye zanda kakhulu njengoko amazwe efuna iindlela ezizodwa zokwenza ukwandiswa kweMedicaid kwaye basebenzise imali eyongezelelweyo yenkxaso-mali eye yawela kumazwe ukuba yandise ukufikeleleka kwi-coverage. Ukuvunywa, isiluleko seCandelo 1115 sokuxhaswa kufuneka kubekho uhlahlo-lwabiwo-mali kwi-federal government (oko kukuthi, urhulumente wesigqeba akasenakuchitha imali ngaphezulu ngokuya kuchitha ngaphandle kwayo).
- Icandelo 1915 (b) ukuxhaswa kuvumela amazwe ukuba aphuhlise izicwangciso zokunyamekela eziMedicaid. Ii-arhente zombuso ze-Medicaid zingenza isivumelwano kunye nemibutho yokunakekela elawulwayo (MCOs) ekuncedeni ukulawula umgangatho, ukusebenzisa, kunye neendleko, ngelixa lizama ukusebenza ekuphuculeni ukusebenza kwenkqubo kunye neziphumo zesigulane. Ii-MCO zibonelela ngeenkonzo zononophelo zempilo kubaxhamli beMedicaid kwaye zifumana iintlawulo zeenkonzo ezivela kwi-fund Medicaid fund.
- Icandelo 1915 (c) IiNkonzo zeeKhaya kunye nezoLuntu (i-HCBS) zivumela abaxhamli ukuba bafumane iinkonzo zonyango lwexesha elide ekhaya okanye kwizicwangciso zoluntu ngaphandle kwezicwangciso zeziko, njengamakhaya asele . Amasiko aseMelika aseMelika angenza isivumelwano kunye namazwe ukulawula u-1915 (c) ukuxhaswa ngeeNkonzo zeMpilo zaseNdiya. Ngaphakathi kwendawo ye-HCBS, amazwe angaphakamisa i-1915 (i) no-1915 (j) ukukhutshwa, kunye no-1915 (k) ukuxhaswa, konke okubonelela ngeengcombolo ezongezelelweyo ekunikezeni i-HCBS kubahlali abafanelekileyo.
- Isiqendu 1915 (b) no-1915 (c) ukukhutshwa kwemvume kuvumela urhulumente ukuba unike iinkonzo ezichongiwe kwiCandelo 1915 (c) ngokubambisana nemibutho yokunyamekela elawulwa kwiCandelo 1915 (b). Imibutho yokunyamekela elawulwa yintengiso inika iinkonzo zonyango ezisekhaya nakwiinkonzo.
Imigaqo kunye neNkqubo yokuVunywa kweNgcaciso
Uhlobo ngalunye lwe-waiver ye-Medicaid luneemithetho eyahlukeneyo esebenza kuyo. Eli phepha linesishwankathelo esifanelekileyo sokukhutshwa okuhlukeneyo, indlela esetyenziswa ngayo, kunye neemfuno ezisetyenziswayo ngamnye.
Uluhlu lwazo zonke iivilisi ezivunyiweyo zeMedicaid ziyafumaneka kwiwebhusayithi yeMedicaid. Iziphakamiso zokurhoxiswa koMbuso zivandlakanywe kwaye zivunyiwe (okanye zigatywe) kwiimeko ezithile. Iziqendu ze-1115 zivunyelwe ukufikelela kwiminyaka emihlanu ekuqaleni, kunye nokuvuselelwa kweminyaka emithathu. Icandelo le-1915 iinqununu ezisetyenziselwa ukuvunyelwa iminyaka engama-amabini, kodwa kwezinye iimeko, nazo ziyakwamkelwa iminyaka emihlanu.
Ziyini Iinkonzo Zenkxaso kunye Neenkonzo Zasekhaya kunye Nezentlalo?
Kwabantu abafuna ukunakekelwa kwexesha elide, njengabantu abadala, i-Medicaid inceda ukuhlawula le nkathalo kumaziko, njengamakhaya asebekhulile. Oku akunakwenzeka ukuba kube njalo okanye kuncedo kumzuzi, nangona kunjalo. Icandelo le-1915 leMedicaid (c) Ukukhutshwa kweeNkonzo zaseKhaya naseNtlalweni kunika iinkonzo kubantu abangahlali emakhaya asebekhulile. Abaxhamli banokuthi bahlale emakhaya abo, okanye bahlala kunye namalungu entsapho okanye abanye abanonophelo, okanye kwiindawo zokuhlala ezixhasayo okanye kwindawo yokuhlala yokuhlala kunye nabahlali ngaphandle kwamakhaya abo okanye amakhaya abo.
Ukuxilongwa "Ukuphuma"
Ukongezelela ekukhutsheni ukudala iinkqubo ezizodwa zeMedicaid, amazwe angakhetha kwakhona "ukuphuma" kwiinkxaso ezithile zeMedicaid kodwa aqhubeke egcina inkxaso-mali eyasungulwa ngaphambili.
UMthetho woNonophelo olungabonakaliyo unika inkxaso-mali yokwandiswa kweMedicaid kwiintsapho ezifumana imali engaphantsi, kwaye abenzi bomthetho babenenjongo yokwamkela loo mali-mali, kunye namazwe awakwazi ukugcina inkxaso-mali ye-Medicaid ye-federal ifumanekanga. Kodwa iNkundla ePhakamileyo iyayilawula ngo-2012 ukuba amazwe akakwazi ukunyanzeliswa ukuba avume inkxaso-mali entsha (kwaye ke, libandakanye isabelo sombuso weendleko zokunyuka kweMedicaid, ekugqibeleni iza kuba ngama-10 ekhulwini weewonke), kwaye ukugatya iMedicaid Inkxaso yokwandiswa ayinakubangela ukuba urhulumente alahlekelwe mali kwi-Medicaid.
Ngenxa yoko, kukho iziganeko ezingama-19 ezingazange zandise iMedicaid, kodwa ezo ziyaqhubeka zifumana inkxaso-mali yazo yangaphambili ye-ACA.
> Imithombo:
> Amasebe e-Medicare neeNkonzo zeMedicaid. Inkcazo kaZwelonke ka-1915 (c) i-HCBS Waivers.
> Medicaid.gov. Malunga neCandelo 1115.
> Medicaid.gov. Amanqanaba okufaneleka afanelekileyo kwi-Medicaid kunye ne-CHIP. Juni 2016.
> Medicaid.gov. Uludwe lweeNgcaciso Zombuso.