Amazwe akakwazi ukufumana iMedicaid ngaphandle kwenkxaso yenkxaso
Ngaphambi kokuba singene kwingxoxo malunga nendlela yokuguqula iMedicaid , kufuneka siyiqonde indlela ulawulo lolawulo lwangoku oluxhasa ngayo imali. Kukho ukwahlukana ngemali ngokusekelwe ekubeni ingaba uhulumeni uthatha inxaxheba ekunyuseni iMedicaid phantsi koMthetho wokuNakekelwa ongenakuncedo, u-Aka Obamacare .
Urhulumente wephondo unikezele ngemali eyongezelelweyo yokuchaza ukwandiswa kweMedicaid, ukuhlawula iipesenti ezili-100 zeendleko zokunyusa iMedicaid nge-2016 kunye ne-90 ekhulwini yeendleko nge-2020.
Zonke iindibano, nokuba zingenayo inxaxheba ekunyukisweni kweMedicaid, zaqhubeka zifumana inkxaso-mali evela kummandla wezi zintathu: Isibhedlele esingabonakaliyo esibhedlele (I-DSH) Iintlawulo, ipesenti ze-Medical Assistance Percentages (FMAP), kunye neeNtengo eziHlanganisiweyo.
Iintlawulo zeZibhedlele ezingabalulekanga
I-Medicaid ayikwazi ngokucacileyo ngokuzinikela xa kuziwa ekuhlawuleleni unyango lwempilo. Ngokweenkcukacha ezivela kwi-Survey Panel Survey ye-2005, ukuchithwa kwezempilo kwalinganiselwa ukuba kuma-26 ekhulwini aphezulu kumntu omdala onomshuwalense wangasese kunokuba umntu kwi-Medicaid ibe ngumgangatho ofanayo wokunyamekela.
Izibhedlele ezinyamekela abantu abaninzi kwiMedicaid okanye abantu abangenakuqinisekiswa, ekugqibeleni, zibuyiselwa ngaphantsi kweendawo eziza kusebenza kwiindawo apho kukho abantu abaninzi abagqitywa ngabashurensi yabucala. Ngo-2016 yedwa, izibhedlele ezingama-21 zivalile iingcango zabo ekunyamekelweni kwabagulayo ngenxa yezinga eliphantsi lokubuyiselwa kwemali kunye nezinye iingxaki zemali.
Ukuphuma kwintsimi yokudlala, iintlawulo ze-Hospital Share (DSH) ezingenakubalwa zaqala ukusebenza. Iimali zedolophu ezongezelelweyo zinikezelwa kumazwe ukuba ahlule phakathi kwezibhedlele ezifanelekileyo ezibona inani elingafaniyo labantu abangenakho i-inshurensi encinane. Injongo yayikukunciphisa umthwalo wemali kulawo maziko ukwenzela ukuba baqhubeke nokubonelela abantu abanemali ephantsi.
Iifomula ezahlukeneyo zisetyenziselwa ukubala inkxaso-mali ye-DSH kwiphondo ngalinye. Ezi fomyula ziqwalasela isabelo se-DSH sonyaka ozayo, ukunyuka kwamaxabiso, kunye nenani labantu abahlala esibhedlele esibhedlele kubantu abangaxhamliyo okanye abangaqinisekanga. Iintlawulo ze-DSH azikwazi ukudlulela iipesenti ezili-12 zomlinganiselo we-Medicaid uncedo lwezonyango zonyango kunoma yimuphi unyaka onikeziweyo.
Amaphesente aseNtshontshi yezoNyango
Ipesenti ze-Federal Medical Assistance (FMAP) zihlala ziyimithombo yokuqala yenkxaso-mali ye-Medicaid. Le ngcamango ilula. Kulo lonke i-$ 1 ilizwe lihlawula i-Medicaid, urhulumente wesigqeba ulingana nama-100 ekhulwini, okt i-dollar ye-dollar. Umoya ophanayo ophezu komntu, ulungelelanisa ngakumbi urhulumente wesigqeba. Akukho zichazi ezichaziweyo, kunye neendleko zenkxaso-mali zonyuka ngokusekelwe kwiimfuno zelizwe.
Xa ucinga ngako, i-FMAP inomdla kodwa ingenakulungile ukuthetha ukuba ithambekele ekubeni nomvuzo ophantsi othe xa kuthelekiswa namazwe anemali ephezulu. Ngokukodwa, kunokuthi kubekho umthwalo okhulayo ukubeka amazwe ngamaqondo aphezulu abantu abahluphekileyo, kwaye i-FMAP inokubuyisela imali engaphantsi kweemfuno zezoqoqosho.
Ukujongana nale mbambano, uMthetho woKhuseleko loLuntu uqikelele ifomula ukubala amaxabiso e-FMAP esekelwe kwisilinganiselo somyinge wesiqingatha sombuso kumyinge wesizwe. Nangona wonke urhulumente athola ubuncinane i-FMAP yeepesenti ezingama-50 (urhulumente wombuso uhlawula iipesenti ezingama-50 zeendleko zeMedicaid, oko kukuthi i-$ 1 ye-$ 1 nganye echithwe nguRhulumente), amanye amazwe aya kufumana ipesenti eziphezulu.
I-Alaska, eCalifornia, e-Connecticut, eMassachusetts , eMassachusetts , eNew Hampshire, eNew Jersey, eNew York, e-North Dakota, eVirginia, eWashington, nase-Wyoming yimi kuphela yodwa ngo-2017 ukuba ibe ne-FMAP ye-50 ekhulwini. Wonke amanye amazwe athola ipesenti ephakamileyo yeemali zeMedicaid evela kurhulumente wephondo.
Ngokuphawulekayo, i-Mississippi inezinga eliphezulu lokufumana ngenkunzi nge-2017 FMAP yama-74,63 ekhulwini. Oku kuthetha ukuba urhulumente wesigqeba ukhokhela iindleko ze-Medicaid ezingama-74.63 zee-Medicaid, ezenza i-$ 2.94 yeedola nganye kwii-1 zeburhulumente.
Ukulinganisa amaRhafu
Amanqanaba afanayo ahambelanayo afana ne-FMAP kodwa athatyathwa elinye inyathelo. Bandisa ipesenti yeendleko ezihlawulwa nguRhulumente wezemfundo kwiinkonzo ezithile. Ezi nkonzo zibandakanya kodwa azithethi:
- Isalathisi somhlaza nesifo somhlaza wesibeleko (ehlawulwa kwizinga le-CHIP FMAP)
- Iinkonzo zocwangciso lweentsapho (ezihlawulwa kwi-FMAP yeepesenti ezingama-90)
- Iinkonzo zezempilo zasekhaya (ezihlawulwa kwi-FMAP yeepesenti ezingama-90)
- Iinkonzo zokukhusela abantu abadala (ezihlawulwa kwi-FMAP + 1 ekhulwini)
* I-CHIP yiNkqubo yeNtsholongwane yezeNtsholongwane yoMntwana
Ezi nkonzo zibonwa zixabisekileyo kuba zinokunceda ukunciphisa umthwalo weendleko zonyango kwixesha elizayo. Ngaloo ndlela, ukuhlawula imali embi ngaphambili kubonwa njengotyalo-mali olufanelekileyo.
Uxhaswa nguRhulumente kwiMedicaid
Masingakulibali ukuba oorhulumente karhulumente bancedisa iidola kwiMedicaid. Indlela abayenza ngayo ihluka ukusuka kwiphondo ukuya kwilizwe, kodwa ukuba bangakanani abachaphazelayo banokuchaphazela uncedo olunjani oluvela kwi-federal government. Inyaniso kukuba akukho oomasipala okanye oorhulumente abanokukwazi ukuhlawula i-Medicaid ngokwabo. Kuphela kunye banokuzibandakanya ngokwaneleyo izibonelelo ukuze banakekele izigidi zabantu abanesidingo.
> Imithombo:
> Ukunakekelwa kweMpilo yoNyango engabonakaliyo. INkquthela yeSizwe yeeNdlu zeeNqununu zeSizwe. http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx. Ukuhlaziywa kweDisemba 1, 2016.
> I-Clemans-Cope L, uHlalahan J, uGarfield R. Medicaid Ukuchitha ukuKhula ngokuthelekiswa nabanye abahlawula: Ukubukela ubungqina. UHenry Kaiser J. Family Foundation. http://kff.org/report-section/medicaid-spending-growth-compared-payers-issue-brief/. Epapashwe ngo-Apreli 13, 2016.
> Ellison A. Ukuvalwa kwezibhedlele ezingama-21 ngo-2016. Ukuhlaziywa kweBitalker Hospital. http://www.beckershospitalreview.com/finance/21-hospital-closures-in-2016.html. Ishicilelwe ngoJanuwari 6, 2017.
> FY2017 Ipesenti zoNcedo lwezoNyango zikaRhulumente. I-Ofisi yoNcedisi uNobhala weCwangciso noVavanyo, iSebe lezeMpilo leSebe lezeMpilo yase-US. https://aspe.hhs.gov/basic-report/fy2017-ederal-medical-assistance-percentages. Ishicilelwe ngoJanuwari 13, 2016.
> Mitchell A. Medicaid Ukwabelana ngokungahambelaniyo nokuhlawula izibhedlele. INkonzo yoPhando lweCongressal. https://fas.org/sgp/crs/misc/R42865.pdf. Ipapashwe ngoJuni 17, 2016.