Indlela Amazwe asebentisa ngayo ama-Medicaid Waiver ukwenza ngezifiso izinhlelo zabo zokuxilonga
I-Medicaid ixhaswe ngokuhlanganyela nguhulumeni wesifundazwe nohulumeni kahulumeni, ukuhlinzeka usizo kubantu ngabanye nemindeni enomholo ophansi ongenawo umshuwalense wezempilo futhi okungenzeka ukuthi ukunakekelwa kwezempilo kungaba yimuphi umthwalo wemali obalulekile. I-Medicaid iphethwe yilowo nalowo wesifundazwe, futhi imithetho yokufaneleka ihluke kusuka kumbuso kuya kuhulumeni.
I-waiver ye-Medicaid ivumela amazwe ukuba avivinye futhi athuthukise izindlela ezinikeza izinhlelo zayo ezixhaswe ngemali e-Medicaid ezihlukile ohlelweni olujwayelekile lwezemfundo.
Lezi zinhlelo zingase zibe nezidingo ezikhethekile zokufaneleka, noma izinhlelo zingase zisebenze njengenhlangano yokunakekelwa ephethwe. Isibonelo, izinhlelo ze-Medicaid zingase zenzelwe abantu abathile abadingayo, njengabadala noma abesifazane abakhulelwe.
E-United States, i-Medicaid yiyona insizakalo yezenhlalakahle enkulu kunazo zonke ezenzelwe usizo lwezokwelapha nezempilo zabantu abahola imali engenayo. Nakuba zonke izifunda zamanje zamukela izimali zeMedicaid futhi zinezinhlelo zabo zeMedicaid , lezo zinhlelo ziyahlukahluka. Ngaphezu kokukwazi ukufaka isicelo se-Medicaid waivers, izifunda zingase futhi "zikhethe ukuphuma" zokwamukela izimali ezintsha zeMedicaid nezidingo.
I-Waiver ingase isetshenziswe ohlelweni lwe-Health Health Insurance (CHIP), olunika izimali zikahulumeni ukuze zifanise izimali zikahulumeni zezinhlelo zokubheka izingane ezingenakuqinisekiswa nemindeni engenayo imali engenayo kodwa zingase zingabi nezidingo zokufaneleka zeMedicaid.
I-Medicaid Waivers
I-medicaid waivers ingahamba ngamagama ahlukahlukene.
Lawa magama afaka ama-1115 waivers (agunyazwe yiSigaba 1115 soMthetho Wokuphepha Komphakathi), ama-1915 waivers (agunyazwe iSigaba 1915 soMthetho Wezokuphepha Komphakathi), izinsizakalo zokuxoshwa, izinhlelo zokuxoshwa, ukuxoshwa kwamakhaya asekhaya kanye nabasebenzi basekhaya (HCBS), kanye amagama ahlukile kunezici ezithile.
Kunezinhlobo eziningana zama-Medicidal waivers, nakuba ziwela ngaphansi kweSigaba 1115 no-1915 soMthetho Wokuphepha Komphakathi:
- Isigaba se-1115 waivers sivumela izinhlelo zokucwaninga nokubonisa ukuthi zenzelwe ukuhlolwa okwesikhashana okufanelekile noma okukhethwa kukho, kanye nezindlela zokweseka nokuletha i-Medicaid. Isigaba se-1115 se-visa sivumela izinhlelo "zokushayela" noma "ukubonisa" okulindeleke ukuthi zithuthukise noma zithuthukise ukufaka nokusebenza kahle. Ngokunwetshwa kwe-Medicaid ngaphansi koMthetho Wokunakekelwa Onganakekelwayo, ama-waivers angu-1115 aseye athandwa kakhulu njengoba amazwe efuna izindlela eziyingqayizivele zokusebenzisa ukwandiswa kweMedicaid futhi basebenzise imali eyengeziwe eyesekela federal eye yagibela emazweni ukwandisa ukufinyelela kokufinyelela. Ukuze kuvunywe, isisombululo se-Section 1115 saiver kufanele sibe isabelomali sokungathathi hlangothi kuhulumeni wesifundazwe (ie, uhulumeni wesifundazwe angeke asebenzise okuningi ngokushiya esikhundleni kunokuba angayichitha ngaphandle kwalo).
- Isigaba 1915 (b) ukuxoshwa kuvumela amazwe ukuba athuthukise izinhlelo zokunakekelwa eziphathekayo ze-Medicaid. Izinhlangano ze-State Medicaid zingakwazi ukubambisana nezinhlangano zokunakekelwa eziphethwe (MCOs) ukusiza ukuphatha ikhwalithi, ukusetshenziswa, nezindleko, kuyilapho futhi kusebenza ukuthuthukisa ukusebenza kwepulani nemiphumela yeziguli. I-MCO inikeza izinsizakalo zokunakekelwa kwezempilo kubazuzi beMedicaid futhi zithola ukukhokhelwa kwalezi zinsizakalo ezivela esikhwameni sikahulumeni saseMedicaid.
- Isigaba 1915 (c) Ukuxoshwa kwezindlu zasekhaya kanye nabomphakathi (HCBS) ukuvumela abahlomuli ukuthola izinsizakalo zokunakekelwa kwezempilo zesikhathi eside ekhaya noma emiphakathini yomphakathi ngaphandle kwezilungiselelo zesikhungo, njengezindlu zokunakekela izingane . Amakhosi aseMelika aseMelika angakwazi ukusebenzisana ne-States ukuphatha ama-1915 (c) ngokulandela iMisebenzi yezeMpilo yaseNdiya. Esikhathini se-HCBS, amazwe angaphinda aphakamise u-1915 (i) no-1915 (j) ukukhishwa, no-1915 (k) ukukhishwa kwempahla, konke okuhlinzekela ukuguquguquka okungeziwe ekunikezeni i-HCBS izakhamuzi ezifanelekile.
- Isigaba 1915 (b) no-1915 (c) ama-awai avumela uhulumeni ukuba unikeze ngezinsizakalo ezikhonjiswe eSigabeni 1915 (c) ngokubambisana nezinhlangano zokunakekelwa eziphathisiwe ezichazwe eSigabeni 1915 (b). Izinhlangano zokunakekelwa ezilawulwayo ezinkontileka ziletha izinsizakalo zokunakekelwa kwezempilo ezisekhaya nasemphakathini.
Imithetho kanye nenqubo yokugunyazwa yokubuyisela
Uhlobo ngalunye lwe-Medicaid waiver lunezimiso ezehlukene ezisebenza kuso. Leli khasi linesifinyezo esihle sokwehlukana okuhlukahlukene, ukuthi zisetshenziselwa kanjani, nezidingo ezisebenza kulowo nalowo.
Uhlu lwawo wonke ama-waivers avunyelwe futhi alindile we-Medicaid luyatholakala kuwebhusayithi ye-Medicaid. Iziphakamiso zokuxoshwa kukaHulumeni zihlolwa futhi zivunyelwe (noma zenqatshelwe) esimweni sokwethenjelwa. Izigaba ze-Section 1115 zivunyelwe iminyaka emihlanu ekuqaleni, ezinokuvuselelwa kweminyaka emithathu. Isigaba se-1915 saye savunywa ukuba sivunyelwe iminyaka emibili, kodwa kwezinye izimo, zingabuye zamukeleke iminyaka emihlanu.
Kuyini Ukunakekelwa Kwezemfundo Nasevisi Yasekhaya Neyomphakathi?
Kubantu abadinga ukunakekelwa isikhathi eside, njengabantu asebekhulile, i-Medicaid isiza ukukhokhela lokhu ukunakekelwa ezikhungweni, njengamakhaya asebekhulile. Lokhu kungenzeka ukuthi akunakwenzeka njalo noma kusize kumzuzi, noma kunjalo. Isigaba 1915 (Medicidal's Section 1915) (c) Ukunikezelwa kwemisebenzi yasekhaya naseKhaya kuhlinzeka ngezinsizakalo kulabo abangahlali emakhaya asebekhulile. Abahlomuli bangase bahlale emakhaya abo, noma bahlale namalungu omndeni noma abanye abahlinzekeli, noma ezindaweni zokuhlala ezithintekayo noma izindawo zokuhlala eziphezulu kanye nemiphakathi ngaphandle kwamakhaya abo noma amakhaya asebekhulile.
I-Medicaid "Khetha ukuphuma"
Ngaphandle kokuyeka ukudala izinhlelo eziyingqayizivele ze-Medicaid, izinhlangano zingase zikhethe futhi "ukuphuma" kwezimali ezithile zeMedicaid kodwa zigcine izimali ezisekelwe ngaphambilini.
I- Care Affordable Act inikeza ngemali yokwandiswa kweMedicaid emindenini engenamali engenayo, futhi abomthetho babenqume ukwenza ukwamukelwa kwezimali ezidingekayo, kanti izifundazwe azikwazi ukugcina imali yabo ekhona yaseMedicaid ekhona uma bengayamukeli imali yokwandisa iMedicaid. Kodwa iNkantolo Ephakeme ilawula ngo-2012 ukuthi asikwazi ukuphoqeleka ukwamukela imali entsha (futhi futhi, sibophe ingxenye yesifundazwe yezindleko zokunwetshwa kweMedicaid, ekugcineni ezoba ngamaphesenti angu-10 ephelele), nokwenqaba iMedicaid Ukuxhaswa ngezimali akuzange kubangele ukuthi umbuso ulahlekelwe yizimali ezikhona zeMedicaid.
Ngenxa yalokho, kunamazwe angu-19 awazange akhulise iMedicaid, kodwa aqhubeka nokuthola imali yabo yase-Medicaid yangaphambi kwe-ACA.
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services. Ukubukezwa Kazwelonke ka-1915 (c) Ama-Waivers we-HCBS.
> Medicaid.gov. Mayelana neSigaba 1115 Imibukiso.
> Medicaid.gov. Amazinga okufaneleka oku-Medicaid ne-CHIP. Juni 2016.
> Medicaid.gov. Uhlu Lwase-State Waivers.