Ziyakukuchaphazela njani?
I-Medicaid yadalwa kunye ne- Medicare ngo-1965. Nangona i-Medicare yayijoliswe ukunikela ngononophelo lwempilo kubantu abadala, injongo yokuxilongwa kwakukubonelela ngoncedo kubantu abangenakukwazi ukuzithengela-abo abanemali ephantsi, abakhubazekileyo, okanye zombini. Abanye abantu banokuba bafaneleke kuzo zombini iinkqubo .
I-Medicaid iyenze utshintsho kwiminyaka, ngokugqithiseleyo ngoMthetho woNonophelo ongenakunceda ngo-2010, owaziwa ngokuba yi-Obamacare.
Ukususela ngowama-2014, i-ofisi yayinokukhetha ukwamkela inkxaso-mali eyongezelelweyo kwixesha elifutshane ukuya ku-2020 ukuqhubela phambili ukwandisa iMedicaid . Ngoku, kubonakala ngathi kukho utshintsho oluninzi olwenzekayo.
NgoJanuwari 11, ngo-2018, amaziko e-Medicare kunye neeNkonzo zeMedicaid, phantsi kwentloko yeCMS, uSeema Vera, ukhuthaze amazwe ukuba avelise iinkqubo zovavanyo ezibeka umsebenzi okanye iimfuno zokuqeqesha umsebenzi kwi-Medicaid. Injongo, uthi, kukuphucula umgangatho wobomi kubantu abakwiMedicaid. Amazwe angenza iziphakamiso zabo ngokuxoshwa, kodwa kufuneka ke afumane imvume yokumisela.
Umba unzima kakhulu kunokuba iCMS ikhokelela ukuba ukholwe.
Umsebenzi kunye nokuPhepha
Kukho konke, umcimbi ungaphantsi malunga nempilo kunye nokuphila kunokuba iidola kunye neenti. Emva kwakho konke, ulawulo lweTrump luye lwazama ukunciphisa amawaka ezigidi zeedola kwiMedicaid ngo-2017 kunye noMthetho wezoMpilo weMpilo waseMelika / uMthetho oLungelelaniso loNxibelelwano loNgcono.
Esikhundleni sokuqhathanisa imali kunye nelizwe, umthetho wawuya kusebenzisa izibonelelo zeblothi okanye imida nganye kwiinkqubo zeMedicaid. Uninzi lwamazwe aluyi kukwazi ukulungiselela ukungaphumeleli kwaye kuzakufuneka ukunciphise inzuzo, ukudala uludwe lwezinto zokulinda, ludinga abantu ukuba bahlawule umrhumo, okanye bafake ezinye iinguqu zokuchithwa kweendleko.
AmaRiphabhulikhi akwenze kucace ukuba bazimisele ukuguqula iMedicaid ngo-2018. Imfuno yomsebenzi yinyathelo lokuqala elijoliswe kuloo njongo. Ezi mfuno zilindeleke ukunciphisa inani labantu abafanelekile kwiMedicaid kunye nokunciphisa ubhaliso lwabantu bonke kwinkqubo. Umphumo jikelele uza kuba kukunciphisa iindleko ze-Medicaid kunye nokunyamekela kwiinkqubo zempilo ezixhaswe ngumqeshi.
Akukho zifundo zokubonisa ukuba ukusebenza kunye ngokwalo kuphucula umgangatho wobomi. Ngokuchasene noko, kukho izifundo ezibonisa ukuba ukwandiswa kweMedicaid kuye kwaphucula iziphumo zempilo kunye nokubandakanyeka koluntu.
Uphononongo luka-2015 kwiphepha le-PLoS One lifanisa abantu abangaphantsi kwe-16,000 abantu abanomvuzo ongezantsi. Abaphandi bafumanisa ukuba abantu abafumana imali engenako kuphela babeba ngabemi abamnyama okanye abasemaphandleni, kodwa nabo banakho amathuba okuba baphumelele kwimpilo xa behlala kumazwe anokwandiswa nguMedicaid.
Xa kufikelele ekubandakanyekeni koluntu, uthi ukunyuswa kweMedicaid kubonise ukwanda kwevolontiya ukusuka kwi-Medicaid abafumanayo. Oku kuboniswa kwisifundo se-2017 kwi-Socius. Ingaba ukuvolontiya kwakusesikweni ngumbutho okanye kungacwangciswanga ngaphakathi kwimizi, amanani ayenyuka kakhulu, ngakumbi kumaqela amancinci.
Abantu abaneziQinisekiso zeMerika kunye neMedicaid Iimfuno zomSebenzi
Ngo-2016, abantu abayizigidi ezingama-72.2 babhalise kule nkqubo. Ngokuqhelekileyo, ininzi yabamkeli beMedicaid ngabantwana. Xa abantwana, asebekhulile kunye nabantu abakwi-Supplemental Security Income (SSI) bengabandakanywa, abantu abadala abayi-24.6 bahlala.
Kulo qela, iipesenti ezingama-60 (14.8 yezigidi) zisebenza-ipesenti ezingama-42 ezipheleleyo (ubuncinane iiyure ezingama-35 ngeveki) kunye neepesenti ezingama-18 zexeshana. Kulabo abangasebenzi (9.8 yezigidi), iipesenti ezili-14 zinezifo okanye ukukhubazeka, iipesenti ezili-12 zibandakanyeka ekunyamekelweni, iipesenti ezi-6 zikolo, kwaye iipesenti ezi-7 azisebenzi kwezinye izizathu.
I-CMS ithi ngokucacileyo ukuba iimfuno zomsebenzi kufuneka ziqwalaselwe kuphela ngabaviwa abanamandla, kodwa abachazi ukuba oko kuthetha ntoni.
Abantu abafanelekayo kwi- Intshurensi yokukhubazeka kweNtlalo (SSDI) banelungelo lokufumana iMedicaid. Nangona kunjalo, ukukhubazeka okuphawulwe yile nkqubo akusoloko kulula. Iimfuno zomeleleyo kwaye uninzi lwamatyala alwaliweyo. Ngo-2010, kuphela iipesenti ezingama-34.8 zee-2,838,485 ezivunyiweyo, ukusuka kuma-56.1 ekhulwini ngo-2000. Enyanisweni, inani leemvume liye lancipha minyaka yonke ukususela ngo-2005. Oku kushiya abaninzi abantu abanokukhubazeka ngaphandle kokukhubazeka okuchaziweyo.
Urhulumente ngamnye uya kufuneka afake izikhokelo zakhe kwinto ethi "uyakwazi". Ngokomzekelo, iKentucky, yokuqala neyokuphela kwimeko yokuba nemfuneko yokusebenza yemvume, iyakwazi abantu abanomdlavuza, ukuphazamiseka kwegazi, okanye ukungcola okanye ukusetyenziswa kakubi kweziyobisi njengokuthi "unobulwelwe."
Ukuwanelisa iMfuno yeMedicaid
Ngokumalunga neemfuno zomsebenzi ngokwazo, iKentucky kunye namanye amazwe asithoba afake isicelo sokukhutshwa. I-Arkansas, iKentucky, neWisconsin idinga iiyure ezingama-80 zomsebenzi ngenyanga; I-Indiana ukuya kwiiyure ezingama-20 ngeveki; I-Arizona, iMaine, ne-Mississippi iiyure ezingama-20 zomsebenzi ngeveki; Kansas naseNew Hampshire ama-20 ukuya kwi-30 iiyure ngeveki; kunye ne-Utah iinyanga ezintathu ezilandelelweyo zophando / uqeqesho ngaphandle kokusebenza iiyure ezingama-30 ngeveki.
Yintoni eyenza "umsebenzi" uphinde uhluke ngurhulumente. Imisebenzi isuka kwingqesho ukuya kwiivolontiya. Oku kuphazamiseka ngokubhekiselele kwisicelo se-Mediaid waiver ngasinye sesisombululo.
- Ukunyamekela umntu ongenamxhomekeke kwimeko yezokwelapha
- Ukunyango kweziyobisi - eKentucky
- Imfundo - iAl Arkansas, eArizona, eIndiya, eKansas, eKentucky, eMaine, eNew Hampshire
- Ingqesho - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah, Wisconsin
- Ukukhangela kweJob - iAccount, eArizona, eIndiya, eKansas, eKentucky, eMaine, eNew Hampshire, eUtah
- Uqeqesho lukaYobhi - i-Arkansas, e-Indiana, eKansas, eKentucky, Mississippi, eNew Hampshire, e-Utah, eWisconsin
- Ukuzithandela - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi
Ukuxolelwa kwiMigca-mfuneko Izidingo zomsebenzi
Akuyena wonke umntu ozakujamelana nomsebenzi weMedicaid. Umbuso ngamnye osebenzayo ngokukhishwa kwemali uchaza ukuba ubani okhululwayo kwimfuno. Ngolunye udidi lokukhululwa, urhulumente angafuna ukuba imilinganiselo eyahlukeneyo ifumaneke.
Ukukhululwa okuqhelekileyo kukudala. Zonke izizathu zithethelela nawuphi na umntu oneminyaka engama-65 ubudala nangaphezulu kule miqathango yomsebenzi. Amanye amazwe avumela ukuguquguquka okukhulu. I-Arkansas neWisconsin baxolela abantu iminyaka engama-50 kunye nabancinci; E-Arizona iminyaka engama-55 kunye ncinane; kunye ne-Indiana ne-Utah iminyaka engama-60 kunye ncinane.
Ukunyamekela abantwana abaneminyaka engama-6 kunye nabancinci okanye umntwana okhubazekileyo okanye umntu omdala ngokubanzi wenza ukuba umntu akhululwe. Amanye amazwe angakwandisa oku kubantwana abadala kunye nokunakekelwa kwabantwana. EKentucky, umntu oyedwa kuphela kwikhaya ngalinye akhululwe xa enyamekela umntwana oncinci okanye umntu omdala onokukhubazeka.
Nangona iiyure ezichithwa unyango lweziyobisi ziyahlangabezana neemfuno zomsebenzi eKentucky, kuthathwa njengento yokuxolelwa e-Arkansas, e-Indiana, eMaine, e-Mississippi, eNew Hampshire, e-Utah naseWisconsin. Abafundi baphinde bakhishwe ngaphandle kwemfuneko. Nangona kunjalo, ubudala bomfundi kunye nenani leeyure zokuhamba kwesikolo liza kudlala. Ukuba unembuyekezo yokungasebenzi kunokukwenza ukuba ukhululeke eMaine, eUutah naseWisconsin kodwa kungekhona kwezinye iindawo eziye zafaka izicelo zokukhutshwa.
Okuthakazelisayo kukuba iKentucky idibene enye indlela entsha kubantu abangazange bahlangabezane nemfuneko yomsebenzi, inkqubela yezempilo kunye neyezemali. Ukongezwa kuye kwaphakamisa iingxaki. Inokungenakulungelelanisa ngokungafanelekileyo abantu abangabonakaliyo ngolwimi olubhaliweyo okanye oluthethiweyo. Kwakhona kunokuba nzima ukuba abantu bazalise ukuba abagqityi imfundo eprayimari.
Iingxabano malunga neemfuno zoMsebenzi
Abo baxhasa iimfuno zomsebenzi waseMedicaid bagxininisa indlela eya kusindisa ngayo imali kumazwe. Ngokuchasene ne-GOP yokuchasana noMthetho woNonophelo ongenakunqwenelekayo, le mfuneko yomsebenzi inokuthi ibe nesiphumo esingalindelekanga sokomeleza. Ukususela ngoJan ngo-2018, iiphondo ezingama-33 kuphela, kuquka iSithili sase-Columbia, zandise ukunyusa iMedicaid. Ukujonga iimfuno zomsebenzi njengendlela yokunciphisa iindleko zeprogram, i-Idaho, i-Kansas, i-North Carolina, i-Utah, iVirginia ne-Wyoming-ngoku iyakwandisa.
Ngoxa iCentecost kulindeleke ukuba igcine iiRandi 2.4 ezigidi kwiindleko zeMedicaid malunga neminyaka emihlanu kunye nesiphakamiso sabo, kulindeleke ukuba abantu abayi-95,000 baya kulahlekelwa yimpilo yabo. I-suit suit action is filed inkundla yenkundla ngomhla kaJan 24 nge-16 iKentucky Medicaid. Bathi iimfuno zomsebenzi zitshintshe injongo ejoliswe ku-Medicaid ekuboneleleni ngoncedo lwabahluphekileyo.
Kukho izicwangciso kwezinye iimeko ukuba urhulumente wesigqeba uyavuma ezinye iimpahia zeMedicaid. Iziphumo zetyala zingathintela ikamva leMedicaid. Ukuphumelela kunokukwenza kube nzima ukuba ulawulo lwangoku luqhubeke nokuguqulwa kweMedicaid ngelixa ilahleko inokuvumela ukuba utshintsho olongezelelweyo kwinkqubo kwixesha elizayo elizayo.
ILizwi
I-Medicaid i malunga nokutshintsha okukhulu. Ukuqala ngo-2018, amazwe angenza isicelo sokongeza iimfuno zomsebenzi kwiinkqubo zabo zeMedicaid. Okwangoku, amazwe alishumi asetyenzisile kwaye ilizwe lokuqala, eKentucky, livunyiwe kunye noshintsho lokuqala lokubakholwa ngoJulayi.
Nangona abanye abantu banokukhululwa kule miqathango yokusebenza ngokusekelwe kwiminyaka, ukunyamekela, ukukhubazeka okanye ukuba ngumfundi osebenzayo, abaninzi abanako. Ingaba okanye awuyiyo okanye imfuneko yeemfuno zeMedicaid, amazwe amaninzi angakhetha ukwandisa iMedicaid ngenxa yoko.
> Imithombo:
> Han X, Nguyen BT, Droped J, Jemal A. Iziphumo ezichaphazelekayo zezempilo phakathi kwabampofu: Ukwandiswa kwemilingo kunye nokungekho Ukwanda kwe-PLoS One. 2015 Dec 31; 10 (12): e0144429. i-doi: 10.1371 / iphephandaba.pone.0144429.
> Mager-Mardeusz H, uLenz C, uKominski GF. "I-Cap" kwiMedicaid: I-Block Grants, ii-Cap Cap Caps, kunye ne-Capped Allotments zinokuthi ziTshintshe ngokuKhuseleko iNet. Umgaqo-nkqubo we-UCLA Cent Policy Policy Res. 2017 kuMatshi; (PB2017-2): 1 10. http://healthpolicy.ucla.edu/publications/Documents/PDF/2017/363%20Medicaid_PB.pdf
> Musumeci M, Garfield R, Rudowitz R. Medicaid kunye Neemfuno Zomsebenzi: Isikhokelo esitsha, Iinkcukacha zoMgaqo-nkqubo weSizwe kunye neengxaki eziphambili. I-Henry J. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/medicaid-and-work-requirements-new-idance-state-waiver-details-and-key-issues/. Ipapashwe ngoJanuwari 16, 2018.
> I-SMD: 18-002, Amathuba okuKhuthaza uMsebenzi kunye nokuBambisana komphakathi phakathi kwabaxhamli beMedicaid. Amaziko e-Medicare neeNkonzo zeMedicaid. https://www.medicaid.gov/federal-policy-guidance/downloads/smd18002.pdf. Ishicilelwe ngoJanuwari 11, 2018.
> Sohn H, i-Timmermans S. Imiphumo yeNtlalo yeNkqubo yokuNakekelwa kwezeMpilo: UkuNyuka kweMilicaid phantsi koMthetho woNonophelo ongenakuncedo kunye neenguqu kwiiVolontiya. Socius. Ngo-2017 uJan-Dec 3. yintoni: 10.1177 / 2378023117700903. Epub Matshi 24, 2017.