Ichakukanganisa sei iwe?
Medicaid yakasikwa pamwe neMedare in 1965. Kunyange zvazvo Medicare yakanga ichida kupa hutano hwakanaka hwehutano kune vakwegura, chinangwa cheMedicaid chaiva chekutarisira vanhu vaisakwanisa kuwana-ivo vane mari shoma, vane urema, kana vose. Vamwe vanhu vangatove vakakodzera kumapurogiramu ose .
Medicaid yakagadziriswa pamusoro pemakore, kunyanya neAffordable Care Act muna 2010, inowanzonzi Obamacare.
Kutanga muna 2014, sangano rakange rine sarudzo yekugamuchira mari yakawedzerwa yehurumende munguva shomanana kuburikidza ne2020 kuti iwedzere Medicaid kuwedzera . Iye zvino, zvinoratidzika kunge zvakanyanya kuchinja kuchinja zvinogona kuitika.
Musi waJanuary 11, 2018, Centers for Medicare neMedicaid Services, pasi peCMS musoro Seema Vera, akakurudzira nyika kuti dzigadzire mapurogiramu epamusoro anokonzera basa kana kuti yekudzidzira basa kune avo vanogamuchira Medicaid. Chinangwa, anoti, ndechekuvandudza hupenyu hwevanhu kune Medicaid. Nyika dzinogona kuita zvirongwa zvavo kuburikidza nemakisiro, asi ivo vanofanira kutora federal.
Nyaya yacho yakaoma zvikuru kupfuura CMS inokutungamirira kuti utende.
Basa uye Utano
Pamwe pese, nyaya yacho haina zvishoma nezvehutano uye hutano hwakanaka kudarika madhora nemakumi. Mushure mezvose, Mutungamiri weTrump akaedza kugura mazana emamiriyoni emadhora kubva kuMedicaid muna 2017 neAmerica Health Care Act yakakundikana / Better Care Reconciliation Act.
Panzvimbo yekufananidza kushandiswa kwemari nematongerwo enyika, mutemo ungadai wakashandisa zvikwereti zvebato kana kuti pamiganhu yemari yekubhadhara Medicaid zvirongwa. Zvizhinji zvematongerwo enyika zvinenge zvisingakwanisi kugadzirisa kukanganisa uye zvinoda kuderedza zvikomborero, kugadzira zvinyorwa zvekumirira, zvinoda kuti vanhu vabhadhara mari yekuvhara, kana kuisa mamwe maitiro ekucheka mari.
VaRepublicans vakaita kuti zvive pachena kuti vanotarisira kuchinja Medicaid muna 2018. Zvido zvebasa ndiyo danho rokutanga kune chinangwa ichocho. Izvi zvinotarisirwa kuderedza nhamba yevanhu vakakodzera kuMedicaid uye kuderedza kuverengwa kwevanhu vose muzvirongwa. Zvose zvinogona kunge zviri kuderedza kushandiswa kweMedicaid uye kushandura kutarisira kune zvirongwa zvehutano zvakabhadharwa.
Pakave pasina zvidzidzo zvinoratidza kuti kushanda mukati uye pachako kunovandudza hupenyu hwehupenyu. Kusiyana naizvozvo, pane zvidzidzo zvinoratidza kuti kuwedzera kweMedicaid kwakagadzirisa zvose zvirwere zvehutano nekubatanidzwa kwevanhu munzvimbo.
Chidzidzo chegore ra2015 mubhuku rinonzi PLoS One rakaenzanisa vanhu vanopfuura 16 000 vanoita mari shoma muhurumende vane uye vasingadi Medicaid kuwedzera. Vatsvakurudzi vakaona kuti havasi ivo chete vaiva nemari yakaderera vaizove vatema kana vagari vomumaruwa, asi ivo vainyanyawo kuva nehutano hwehutano kana vakagara mune dzimwe nyika dzaive neMedicaid kuwedzera.
Kana zvasvika pakubatanidzwa kwemunharaunda, inotaura nekuwedzera kweMedicaid yakaratidza kuwedzera kwekuzvipira kubva kune avo vanogamuchira Medicaid. Izvi zvinoratidzwa muchidzidzo che 2017 mubhuku re Socius. Pasinei nokuti kuzvipira kwaive kwakarongeka kuburikidza nesangano kana kuti zvisina kurongwa mukati memunharaunda, mitero yakanyanya kuwedzera, kunyanya mumapoka maduku.
Able-Bodied America uye Medicaid Basa Rinodiwa
Muna 2016, vanhu 72.2 mamiriyoni vakanyoresa purogiramu. Kazhinji kutaura, vazhinji veMedicaid vanogamuchira vana. Pane imwe nguva vana, vakwegura, uye vanhu vari kuAdhealthal Security Income (SSI) vakabviswa, vanhu vakuru vanosvika 24.6 vanogara.
Pakati peboka iroro, 60 kubva muzana (14.8 mamiriyoni) vari kushanda-42 muzana nguva yakazara (maawa makumi matatu nemavhiki pavhiki) uye 18 muzana chikamu-nguva. Kune avo vasingashandisi (mamiriyoni 9,8), 14 muzana vane chirwere kana urema, 12 muzana vanobatanidzwa mukuchengeta, 6 muzana vari kuchikoro, uye 7 muzana havasi kushanda kune zvimwe zvikonzero.
CMS inotaura zvakananga kuti basa rinodiwa rinofanira kungotaridzirwa kune avo vanogona kubhabhatidzwa, asi havanotsananguri kuti zvinorevei.
Vanhu vanokodzera Social Security Disability Insurance (SSDI) vanofanirwawo neMedicaid. Zvisinei, kuva nekuremara kunozivikanwa nezvirongwa izvi hakusi nyore nguva dzose. Izvo zvinotarisirwa zvakaoma uye huwandu hwemhosva hunorambidzwa. Muna 2010, 34,8 muzana chete yezvidzidzo 2,838 485 dzakabvumidzwa, kubva pasi kubva ku 56.1 muzana muna 2000. Kutaura zvazviri, nhamba yekubvumirwa yakaderera gore negore kubvira muna 2005. Icho chinosiya vanhu vazhinji vane hutachiona vasina hutano hwakatsanangurwa.
Hurumende imwe neimwe inoda kuisa mirayiridzo yayo yezvainoona se "yakakwanisa". Semuenzaniso, Kentucky, yekutanga uye yega yega yekuve nebasa rinofanira kuitwa waiver rinogamuchirwa, rinoziva vanhu vane kenza, kushushikana kweropa, kana doro kana doro rekushandisa zvinodhaka se "mishonga isina simba."
Kuzadzisa Medicaid Work Requirement
Nezvekudiwa kwebasa ivo pachavo, Kentucky neyepfumbamwe dzimwe nyika dzakatsvaga kuti dzisiye. Arkansas, Kentucky, uye Wisconsin inoda maawa 80 ebasa pamwedzi; Indiana kusvika kumaawa makumi maviri nevhiki; Arizona, Maine, uye Mississippi Maawa makumi maviri emabasa evhiki; Kansas neNew Hampshire maawa 20 kusvika ku30 pavhiki; uye Utah mwedzi mitatu inotevera mutsva yekutsvaga basa / kudzidzisa kunze kwekuti vari kushanda maawa 30 pavhiki.
Chii chinoreva "basa" chinoparadzaniswa nenyika. Mabasa anowanikwa kubva kumabasa kusvika pakuzvipira. Uku ndiko kuputsika maererano nehurumende imwe neimwe yeMedicaid yaiver yezvino.
- Kuchengetedza kune munhu asiri mumiririri ane chirwere chinoshayisa kurapa - Kentucky
- Kurapa zvinodhaka - Kentucky
- Dzidzo - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire
- Employment - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah, Wisconsin
- Job search - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire, Utah
- Job training - Arkansas, Indiana, Kansas, Kentucky, Mississippi, New Hampshire, Utah, Wisconsin
- Kuzvipira - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi
Kuvhiringidzwa Kubva muMedicaid Basa Rinodiwa
Haasi munhu wose achasangana nebasa reMedicaid. Hurumende imwe neimwe iyo inoshanda nokuda kwekuregererwa inotsanangura kuti ndiani anoregererwa pane zvinodiwa. Kune rumwe rutivi rwekuregererwa, hurumende inogona kudikanwa kuti zvirongwa zvakasiyana siyana zviitwe.
Kuvhiringidzika kunowanzoita makore. Zvose zvinoremekedza chero ani zvake makore makumi matanhatu nekure kubva pamabasa aya. Mamwe masangano anobvumira kushanduka kwakawanda. Arkansas neWisconsin vanodzinga vanhu makumi mashanu nemakore; Arizona makore makumi mashanu nemuduku; uye Indiana neUtah makore makumi matanhatu uye vaduku.
Kuchengetera vana makore matanhatu uye vaduku kana kune mwana akaremara anoremara kana munhu mukuru zvinowanzoita kuti munhu asunungurwe zvakare. Vamwe vanogona kuwedzera izvi kune vana vakwegura uye kunyange kutarisira vana. MuKentucky, munhu mumwe chete weimba yega wega anenge asingabhadharwi kana akatarisira mumwe munhu akaremara kana munhu mukuru ane hurema.
Kunyange zvazvo maawa anoshandiswa mukurapa zvinodhaka anosangana nebasa rekuita kuKentucky, rinofungidzirwa kusunungurwa muA Arkansas, Indiana, Maine, Mississippi, New Hampshire, Utah, uye Wisconsin. Vadzidzi vakadzingwawo kubva pane zvinodiwa. Zvisinei, nguva yemudzidzi uye nhamba yeawa yekupinda kuchikoro inogona kuitika. Kuva mukubhadhara kwemabasa kunogona kukuita kuti usasunungurwe muMaine, Utah, uye Wisconsin asi kwete mune imwe iyo iyo iyo yakashandisa kubhadhara.
Zvinofadza kuti Kentucky yakawedzera imwe nzira itsva kune vanhu vasingamboiti basa rinodiwa, hutano uye mari yekudzidza. Kuwedzera kwakakonzera kunetseka. Zvinogona kusaruramisira vanhu vasina kunyatsorondedzera mumitauro yakanyorwa kana kutaura. Zvinogonawo kuva zvakaoma kuti vanhu vagedze kana vasina kupedza dzidzo yepuraimari.
Dharoro pamusoro peMedicaid Work Requirements
Avo vanotsigira Medicaid basa rinodiwa zvinomiririra kuti ichachengetedza sei mari yehurumende. Kusiyana neGOP inopesana neAne Affordable Care Act, izvi zvinoda basa zvinogona kuva nemigumisiro isingatarisirwi yekuisimbisa. Kubva munaJan. 2018, nyika dze 33 chete, kusanganisira District of Columbia, dzakanga dzatsvaga Medicaid kuwedzera. Kutarisa kumabasa ekushanda senzira yekuderedza hurongwa hweprogram, dzimwe nyika-Idaho, Kansas, North Carolina, Utah, Virginia, neWyoming-zvino vari kutarisa kuwedzera.
Kunyange zvazvo Kentucky inotarisirwa kuchengetedza $ 2.4 mabhiriyoni muMedicaid mari kwemakore mashanu neanofunga, zvinotarisirwa kuti vanhu 95 000 vacharasikirwa nehutano hwavo. Chikoro chechiitiko chekutsva chikaiswa mudare rehurumende paJan 24 ne16 Kentucky Medicaid vanogamuchira. Vanoti basa rinodiwa rinoshandura chinangwa chinangwa che Medicaid icho chiri kupa hutano kuvarombo.
Ikoko kunogona kunge kune zvipfeko mune dzimwe zviti kana hurumende yehurumende inobvumira zvimwe zveMedicaid waivers. Migumisiro yemhosva ingakanganisa ramangwana reMedicaid. Mukukunda kunogona kuita kuti zvive zvakaoma kuti hurumende iripo irambe ichienderera mberi neMedicaid shanduko apo kurasikirwa kunogona kubvumira zvimwe kuchinja purogiramu munguva yemberi iri pedyo.
Shoko Rinobva
Medicaid iri kuda kuchinja zvimwe zvinhu. Kutanga muna 2018, nyika inogona kushandiswa kuwedzera basa rinodiwa kune zvirongwa zveMedicaid. Kusvika iye zvino, nyika dzine gumi dzakashandisa uye nyika yekutanga, Kentucky, yakabvumidzwa nekunyoreswa kwekutanga kuitika muna July.
Kunyange zvazvo vamwe vanhu vangave vasingabhadharwi nemabasa aya zvichienderana nezera, kutarisira, kuremara, kana kuti kuva mudzidzi anoshingaira, vazhinji havazoiti. Ungave kana usati uri kana kuti unopesana neMedicaid basa rinodiwa, mamwe mahurumende angasarudza kuwedzera Medicaid semugumisiro.
> Sources:
> Han X, Nguyen BT, Drope J, Jemal A. Zviitiko zvine chokuita nehutano pakati pevarombo: Kuwedzerwa kweMedicaid vs. Kusasarudzirwa PLoS One. 2015 Dec 31; 10 (12): e0144429. doi: 10.1371 / magazini.pone.0144429.
> Mager-Mardeusz H, Lenz C, Kominski GF. A "Cap" paMedicaid: MaBlock Grants, Per Capita Caps, uye Capped Allotments Zvinogona Kuchinja Pamwe Chete Net Safety Net. Bumbiro Bfupi UCLA Cent Health 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 neMabasa Anoshanda: Nhungamiro Itsva, State Waiver Details uye Zvimwe Zvikamu. Henry J. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/medicaid-and-work-requirements-new-guidance-state-waiver-details-and-key-issues/. Yakabudiswa naJanuary 16, 2018.
> SMD: 18-002, mikana yekusimudzira basa nekubatanidzwa kwemunharaunda pakati pemishandiro vanobatsira. Nzvimbo dzeMedare uye Medicaid Services. https://www.medicaid.gov/federal-policy-guidance/downloads/smd18002.pdf. Yakabudiswa naJanuary 11, 2018.
> Sohn H, Timmermans S. Shanduko dzehutano hwehutano Reform: Kuwedzerwa kweMedicaid pasi peChinakidza Care Care Act uye Kuchinja Mukuzvipira. Socius. 2017 Jan-Dec 3. nei: 10.1177 / 2378023117700903. Epub March 24, 2017.