Ziyokuthinta kanjani?
I-Medicaid yadalwa eceleni kwe- Medicare ngo-1965. Ngenkathi iMedare yayihloselwe ukuhlinzeka ngempilo yokwanela kubantu abadala, umgomo weMedicaid kwakuwukuhlinzeka abantu abangenakukwazi ukuyikhokhela-labo abanemali ephansi, abakhubazekile, noma kokubili. Abanye abantu bangase bafaneleke kokubili izinhlelo .
I-Medicaid yenze izinguquko eminyakeni, ikakhulukazi nge-Care Affordable Act ngo-2010, eyaziwa ngokuthi yi-Obamacare.
Kusukela ngo-2014, kusho ukuthi kunenkululeko yokwamukela izimali ezengeziwe zezimali zikahulumeni ngesikhathi esifushane ngo-2020 ukuze kuqhutshwe ukwandiswa kwe-Medicaid . Manje, kubonakala sengathi izinguquko ezishintshayo zingase zenzeke.
NgoJanuwari 11, 2018, amaCenter for Medicare and Medicaid Services, ngaphansi kweCMS, oyinhloko yeSeema Vera, uye wakhuthaza ukuthi ukuklama izinhlelo zokushayela ezibeka umsebenzi noma izidingo zokuqeqeshwa komsebenzi kubamukeli be-Medicaid. Umgomo, uthi, ukuthuthukisa ikhwalithi yokuphila kubantu abakuMedicaid. Amazwe angenza iziphakamiso zawo ngokusebenzisa ama-waivers, kodwa kumele athole ukugunyazwa kwe-federal.
Inkinga yinkimbinkimbi kakhulu kuneCMS ekuholela ekukholweni.
Umsebenzi nokuPhepha
Kungenzeka ukuthi le nkinga ingaphansi kwezempilo nempilo kunokungaba ngama-dollar namasenti. Phela, umphathi we-Trump wazama ukunciphisa amakhulu ezigidi zamaRandi ukusuka eMedicaid ngo-2017 nge-American Impilo Care Act / Umthetho Wokunakekelwa Kokunakekelwa Okungcono.
Esikhundleni sokuqhathanisa imali nemali, umthetho wawuzosebenzisa izibonelelo ze-block noma imikhakha ngayinye yokuxhasa izinhlelo ze-Medicaid. Iningi lamazwe ngeke likwazi ukulungiselela ukulahleka futhi lizodinga ukunciphisa izinzuzo, ukudala izinhlu zokulinda, zidinga abantu ukuthi bakhokhele ukukhokhelwa, noma bafake ezinye izinguquko zokunciphisa izindleko.
AmaRephabliki akwenze kucacise ukuthi ahlose ukuguqula iMedicaid ngo-2018. Izidingo zomsebenzi ziyisinyathelo sokuqala sokufinyelela kulowo mgomo. Lezi zidingo kulindeleke ukunciphisa inani labantu abafanelekile kwi-Medicaid nokunciphisa ukubhaliswa jikelele kuloluhlelo. Umthelela jikelele uzoba ukunciphisa ukusetshenziswa kweMedicaid nokushintsha ukunakekelwa kwezinhlelo zempilo ezixhaswe ngumqashi.
Akubekho izifundo zokubonisa ukuthi ukusebenza ngaphakathi ngokwakho kuthuthukisa ikhwalithi yokuphila. Ngokuphambene nalokho, kunezifundo ezibonisa ukuthi ukunwetshwa kwe-Medicaid kuye kwaphuthukisa kokubili imiphumela yezempilo nokubandakanyeka komphakathi.
Ucwaningo luka-2015 emaphepheni i-PLoS One liqhathanisa abantu abangaphezu kuka-16 000 abanomholo ophansi abangenawo futhi ngaphandle kokunwetshwa kwe-Medicaid. Abacwaningi bathola ukuthi akubona nje ukuthi abantu abahola imali abaphansi babengabahlali abamnyama noma basezindaweni zasemaphandleni, kodwa futhi banamathuba amaningi okuba nemiphumela engcono yempilo uma behlala emazweni ayenwe ukukhula kweMedicaid.
Uma kuziwa ekubandakanyekeni komphakathi, kusho ukuthi ukwandiswa kweMedicaid kubonise ukukhuphuka kokuvolontiya kwabamukeli babo be-Medicaid. Lokhu kuboniswa kwisifundo se-2017 emaphepheni we-Socius. Kungakhathaliseki ukuthi ukuzithandela kwakungokomthetho ngokusebenzisa inhlangano noma kungakahleleki ngaphakathi kwamakhelwane, amazinga ayekhuliswe ngokuphawulekayo, ikakhulukazi emaqenjini amancane.
Ama-American Able-Bodied Bodied and Medicaid Izidingo zomsebenzi
Ngo-2016, abantu abangu-72.2 million babhalisiwe ohlelweni. Ngokuvamile, iningi labamukeli be-Medicaid yizingane. Uma izingane, abantu asebekhulile, kanye nabantu abasele ku-Supplemental Security Income (SSI) bengabanjwanga, abantu abadala abayizigidi ezingu-24.6 bahlala.
Kulelo qembu, amaphesenti angu-60 (ama-14.8 million) asebenza-amaphesenti angu-42 egcwele (okungenani amahora angu-35 ngesonto) kanye nesilinganiso se-18%. Kulabo abangasebenzi (9.8 million), amaphesenti angu-14 anesifo noma ukhubazekile, amaphesenti angu-12 ahilelekile ekunakekeleni, amaphesenti angu-6 ase esikoleni, kanti amaphesenti angu-7 awasebenzi kwezinye izizathu.
I-CMS ithi ngokucacile ukuthi izidingo zomsebenzi kufanele zicatshangelwe kuphela kubakhethiweyo abakwaziyo, kodwa azichazi ukuthi kusho ukuthini lokho.
Abantu abafanelwe Umshuwalense Wokukhubazeka Kwezenhlalakahle (SSDI) nabo bafanelekela iMedicaid. Noma kunjalo, ukukhubazeka okuqashelwa yizinhlelo akulula ngaso sonke isikhathi. Izindlela ziqinile futhi iningi lamacala liphikisiwe. Ngo-2010, kuphela amaphesenti angu-34.8 wezicelo ezingu-2,838,485 avunyelwe, wehla ngamaphesenti angu-56.1 ngo-2000. Eqinisweni, inani lezimvume liye lancipha minyaka yonke kusukela ngo-2005. Lokhu kushiya abantu abaningi abanezinkinga ngaphandle kokukhubazeka okuchazwe.
Umbuso ngamunye uzodinga ukubeka imihlahlandlela yayo yalokho okubonakala ukuthi "uyakwazi". Isibonelo, iKentucky, isimo sokuqala nesisodwa kuphela sokuba nesimiso semisebenzi esivumelekile, siyabona abantu abane-cancer, ukuphazamiseka kwegazi, noma isifo sokuphuza ngokweqile noma izidakamizwa njenge "ukuhluleka kwemithi."
Ukwanelisa Isidingo Somsebenzi Wokuxilongwa
Ngokuqondene nezidingo zomsebenzi ngokwazo, eKentucky nakwamanye amazwe ayisishiyagalolunye afake isicelo sokuxoshwa. I-Arkansas, iKentucky, neWisconsin idinga amahora angu-80 ngenyanga; Indiana kuze kube amahora angu-20 ngesonto; I-Arizona, iMaine, ne-Mississippi umsebenzi wamahora angu-20 ngesonto; Kansas naseNew Hampshire amahora angu-20 kuya kwangu-30 ngesonto; ne-Utah izinyanga ezintathu ezilandelanayo zokufuna umsebenzi / ukuqeqeshwa ngaphandle uma besebenza ngamahora angu-30 ngesonto.
Lokho okusho ukuthi "umsebenzi" futhi kuhlukahluka nombuso. Imisebenzi ibanga ukusuka emsebenzini kuya ekuzithatheni. Lokhu kuphazamiseka ngokusho kwesicelo seMedicaid waiver esivela kunazo zonke emhlabeni.
- Ukunakekelwa kokunakekela umuntu ongencike onesifo sokukhubazeka - eKentucky
- Ukwelapha izidakamizwa - eKentucky
- Education - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire
- Umsebenzi - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah, Wisconsin
- Ukusesha uJobe - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire, Utah
- Ukuqeqeshwa kukaJobe - i-Arkansas, i-Indiana, i-Kansas, i-Kentucky, i-Mississippi, i-New Hampshire, i-Utah, i-Wisconsin
- Ukuzithandela - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi
Izibonelo Ezivela Emilenzeni Imisebenzi Yokusebenza
Akuwona wonke umuntu oyobhekana nemfuneko yomsebenzi we-Medicaid. Isimo ngasinye esisebenzela ukukhishwa kwemali sichaza ukuthi ubani okhululwa emfuno. Ngokwesigaba ngasinye sokuxoshwa, umbuso ungadinga ukuthi izindlela ezihlukene zihlangane.
Ukukhululwa okuvame kakhulu kuneminyaka yobudala. Zonke izizathu zibalela noma ubani oneminyaka engu-65 nangaphezulu kusuka kulezi zidingo zomsebenzi. Amanye amazwe avumela ukuguquguquka okuningi. I-Arkansas neWisconsin ikhulula abantu eminyakeni engu-50 nangaphansi; I-Arizona iminyaka engu-55 futhi encane; futhi e-Indiana nase-Utah iminyaka engu-60 futhi encane.
Ukunakekela izingane iminyaka engu-6 noma encane noma ingane encane ekhubazekile noma omdala ngokuvamile kwenza umuntu akhululeke. Ezinye izifunda zingase zenze lokhu kubantwana abadala kanye nokunakekelwa kwabantwana. E-Kentucky, umuntu oyedwa kuphela ekhaya ngalinye akhululekile uma enakekela ingane encane noma umuntu omdala onokukhubazeka.
Nakuba amahora asetshenziselwa ukwelashwa kwezidakamizwa ahlangabezana nemfuneko yomsebenzi eKentucky, kuthathwa njengokukhululwa e-Arkansas, e-Indiana, e-Maine, e-Mississippi, eNew Hampshire, e-Utah nase-Wisconsin. Abafundi nabo bakhishwe ngaphandle kwemfuneko. Kodwa-ke, iminyaka yomfundi kanye nenani lamahora wokuba khona kwesikole angase adlale. Ukuthola isinxephezelo sokungasebenzi kungakwenza ube nokukhululeka eMaine, e-Utah naseWisconsin kodwa hhayi kwenye indawo esetshenziselwe ukuxoshwa.
Ngokuthakazelisayo, iKentucky ingeze enye indlela eminye kubantu abangazange bahlangabezane nemfuneko yomsebenzi, inkambo yezokwelapha nokufunda ngezezimali. Ukwengeza kuye kwaphakamisa ukukhathazeka. Kungase kube inselele ngokungalungile abantu abangaphili kahle ngolimi olulotshiwe noma olukhulunywayo. Kungase kube nzima ukuba abantu baqede uma bengakapheli imfundo eyisisekelo.
Ukuphikisana kwezidingo zomsebenzi weMedicaid
Labo abasekela izidingo zomsebenzi we-Medicaid bagcizelela ukuthi kuzosindisa kanjani imali ezizweni. Ngokuphambene nokuphikisana kwe-GOP kuMthetho Wokunakekelwa Onganakekelwayo, lezi zidingo zomsebenzi zingase zibe nomphumela ongahlosiwe wokuwuqinisa. Kusukela ngoJanuwari 2018, izifunda ezingu-33 kuphela, kuhlanganise neSifunda saseColombia, zenze ukuthuthukiswa kweMedicaid. Ukubheke emigomweni yokusebenza njengendlela yokunciphisa izindleko zohlelo, izifunda eziningi-Idaho, Kansas, North Carolina, Utah, Virginia, nase-Wyoming-manje zifuna ukwandisa.
Ngenkathi iKentucky kulindeleke ukuthi ingalondolozi iRandi 2.4 billion izindleko zeMedicaid eminyakeni emihlanu ngesiphakamiso sabo, kulindeleke ukuba abantu abangu-95 000 balahlekelwe impilo yabo. Isitatimende sokwenza isigaba sifike enkantolo yenkantolo ngomhla kaJan. 24 no-16 abamukeli baseKentucky Medicaid. Bathi izidingo zomsebenzi zishintsha injongo ehlosiwe ye-Medicaid okuzohlinzeka ngempilo yabampofu.
Kungase kube nezicucu kwamanye amazwe uma uhulumeni wesifunda evuma amanye ama-waivers e-Medicaid. Imiphumela yecala lingathinta ikusasa le-Medicaid. Ukuwina kungenza kube nzima ukuphathwa kwamanje ukuqhubeka nokuguqulwa kweMedicaid ngenkathi ukulahlekelwa kungavumela izinguquko eziningi ohlelweni esikhathini esizayo esiseduze.
Izwi elivela
I-Medicaid izokwenzeka ushintsho olukhulu. Kusukela ngo-2018, izifunda zingasebenza ukwengeza izidingo zomsebenzi ezinhlelweni zabo ze-Medicaid. Kuze kube manje, amazwe ayishumi asetshenzisiwe futhi umbuso wokuqala, eKentucky, uvunyelwe ngezinguquko zokuqala zokubhalisa ezenzeka ngoJulayi.
Ngenkathi abanye abantu bengase bakhululwe kulezi zidingo zomsebenzi ngokususelwa eminyakeni yobudala, ukunakekelwa, ukukhubazeka, noma ukuba ngumfundi osebenzayo, abaningi ngeke. Kungakhathaliseki ukuthi ungewona noma awuhambisani nezimfuneko zomsebenzi we-Medicaid, amazwe amaningi angakhetha ukwandisa iMedicaid njengomphumela.
> Imithombo:
> Han X, Nguyen BT, Drope J, Jemal A. Imiphumela ehlobene nempilo phakathi kwabampofu: Ukwandiswa kwezidakamizwa nokungahambisani nokuthuthukiswa PLoS One. 2015 Dec 31; 10 (12): e0144429. i-doi: 10.1371 / iphephandaba.pone.0144429.
> Mager-Mardeusz H, uLenz C, Kominski GF. "I-Cap" ku-Medicaid: Indlela Ukuvimba Izibonelelo, Amapokhethi Ase-Capita, nama-Capped Allotments Kungashintsha Ngokuyisisekelo Ukuphepha Net. Inqubomgomo kafushane ye-UCLA Cent Policy Policy Res. 2017 Apr; (PB2017-2): 1 10. http://healthpolicy.ucla.edu/publications/Documents/PDF/2017/363%20Medicaid_PB.pdf
> Musumeci M, Garfield R, Rudowitz R. Medicaid kanye Nezimfuneko Zomsebenzi: Isiqondiso Esisha, Imininingwane Yomhlaba Waiver kanye Nezindaba Eziyinhloko. I-Henry J. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/medicaid-and-work-requirements-new-guidance-state-waiver-details-and-key-issues/. Ishicilelwe ngo-January 16, 2018.
> I-SMD: 18-002, Amathuba Wokukhuthaza Umsebenzi Nokuzibandakanya Komphakathi Phakathi Nabahlomuli beMithiya. Amasevisi we-Medicare neMediicaid Services. https://www.medicaid.gov/federal-policy-guidance/downloads/smd18002.pdf. Ishicilelwe ngoJanuwari 11, 2018.
> Sohn H, Timmermans S. Imiphumela Yezenhlalakahle Zokuguqulwa Kwezempilo: Ukukhuliswa Kwemithi Ngaphansi Komthetho Wokunakekelwa Ongathintekayo kanye Nezinguquko Ekuzithatheni. I-Socius. 2017 Jan-Dec 3. sinayo: 10.1177 / 2378023117700903. Epub March 24, 2017.