Ihurumende haigoni kutenga Medicaid pasina sangano rekusimudzira
Tisati tasvika mukukakavadzana pamusoro pekuchinja kweMedicaid , tinofanira kunzwisisa kuti hurumende yehurumende ikozvino inopa sei purogiramu. Kune kusiyana kwekubhadhara kunobva pasinei nokuti hurumende inobatanidzwa muMedicaid kuwedzerwa pasi peAne Affordable Care Act, aka Obamacare .
Hurumende yehurumende yakapa mari yezvezvematongerwo enyika kudarika kuwedzera kweMedicaid, kuripa 100 muzana yeMedicaid yekuwedzera mari kuburikidza ne 2016 ne90 muzana yeiyo inotora kusvika muna 2020.
Zvose zvinotaura, kana kuti kwete ivo vanobatanidzwa muMedicaid kuwedzera, vakaramba vachiwana mari yekubhadhara mari kubva kune idzi zvitatu zvinobva: Disproportionate Share Hospital (DSH) Maripo, Federal Medical Assistance Percentages (FMAP), uye Kuwedzerwa Kufananidza Matengo.
Zvisingabatsiri Igovana Chipatara Zvokubhadhara
Medicaid hainyatsozivikanwi nekuda kwekupa rupo kana zvichiuya pakubhadhara utano. Maererano nenhoroondo kubva muna 2005 Medical Expenditure Panel Survey, kushandiswa kwehutano hwehutano kunofungidzirwa kuva 26 muzana kune mumwe munhu mukuru ane inshuwarisi yega yega kune mumwe munhu muMedicaid yehutano hwakadaro.
Zvipatara zvinotarisira vanhu vakawanda muMedicaid kana kuvanhu vasina kuvimbiswa, pakupedzisira, vanobhadharwa zvishoma kudarika zvivako zvinoshanda munzvimbo umo pane vanhu vakawanda vakafukidzwa nehuturi yechushuga. Muna 2016 chete, zvipatara 21 zvakavhara magedhi avo kune vakwegura vasina hanya nekuda kwekubhadharwa kwekubhadhara mari uye zvimwe zvinetso zvemari.
Kuda kunyange kunze kwekutamba, Kubhadhara kwaDisproportionate Share Hospital (DSH) kwakatanga kushanda. Zvimwe mari yehurumende inopiwa kuhurumende kuti iparadzanise pakati pezvipatara zvakakodzera izvo zvinoona nhamba isina kukwana yevanhu vane zvishoma zvisingashandisi inshuwarisi. Pfungwa iyi yaiva yekuderedza mutoro wezvemari kune zvivako izvo kuitira kuti vagone kuramba vachipa vanhu vane mari shoma.
Mavara akasiyana-siyana anoshandiswa kuverenga federal DSH mari yehurumende imwe neimwe. Iyi mazano inofunga nezvekushandiswa kweDSH yegore risati rapera, kuwedzera kwenyika, uye nhamba yevasati vashandi vezvipatara kune vanhu veMedicaid kana vasina kuvimbiswa. DH payments haigoni kudarika 12 muzana yehurumende yenyika yose Medicaid rubatsiro rwekurapa kwemari kune chero gore rakapiwa.
Sangano reMudhipatimendi Rubatsiro Mazana
Sangano reMudhipatimendi reRubatsiro Pureji (FMAP) rinoramba richiita sangano reMedicaid mari. Iko pfungwa iri nyore. Kuda mari imwe neimwe yehurumende inobhadhara Medicaid, hurumende yehurumende inofananidzwa nayo inenge zana muzana, kureva madhora emadhora. Nyika inopa rupo iri kufukidza vanhu, iyo inopa rupo hurumende yehurumende inoda kuve. Icho hapana chinotsanangurwa chinyorwa, uye federal expenditures inowedzera maererano nezvinodiwa nehurumende.
Apo iwe unofunga pamusoro pazvo, FMAP inopa asi inogona kunge isina kunyatsokodzera kutaura kuti inowanzova nemari yakaderera yemari kana ichienzaniswa nehurumende ine mari yakakwirira. Kunyanya, pangangodaro kuwedzerwa mutoro kunowedzera nyika nepamusoro-soro yevarombo, uye FMAP inogona kupa reproportionally low reimbursement pasinei nezvido zvehupfumi zvehurumende.
Kuti igadzirise nyaya iyi, Social Security Act yakaronga nzira yekuverenga FMAP mazinga zvichienderana nehurumende yepakati yemari yakaenzana neyenharaunda yenyika. Kunyange zvazvo nyika yose inogamuchira zvishoma FMAP ye50 muzana (hurumende yehurumende inopa 50 muzana yeMedicaid mari, kureva $ 1 ye $ 1 inoshandiswa nehurumende), dzimwe nyika dzichagamuchira zvikamu zvepamusoro.
Alaska, California, Connecticut, Maryland, Massachusetts , Minnesota, New Hampshire, New Jersey, New York, North Dakota, Virginia, Washington, uye Wyoming ndiyo chete inoti muna 2017 kuva FMAP ye50 muzana. Mamwe mamwe mahedheni anogamuchira chikamu chikuru cheMedicaid mari kubva kuhurumende yehurumende.
Zvinonzwisisika, Mississippi ine yepamusoro yepamusoro yepamusoro yepamusoro yepamusoro ne 2017 FMAP ye 74.63 muzana. Izvi zvinoreva hurumende yehurumende inobhadhara 74.63 muzana yenyika yeMedicaid mari, inopa $ 2.94 ye $ 1 yose iyo nyika inopedzera.
Kuwedzerwa Kuenzanisa Mitengo
Kuwedzerwa kuenzanirana kwemitengo kwakafanana ne FMAP asi zvinotorwa nhanho imwe mberi. Vanowedzera chikamu chemari inobhadharwa nehurumende yehurumende kune mamwe mabasa. Izvi zvinosanganisira asi hazvirevi kune:
- Chirwere uye mushonga wechirwere chepervical (yakabhadharwa nechechi CHIP FMAP mutengo *
- Mazano ekuronga mhuri (akabhadhara pa FMAP ye 90 muzana)
- Mishonga yehutano yepamusha (yakabhadharwa pa FMAP ye 90 muzana)
- Zvidziviriro zvekuchengetedza vanhu vakuru (yakabhadharwa pa FMF + 1 muzana)
* CHIP inonzi Child Health Insurance Program
Aya maitiro anoonekwa seanokosha nokuti anogona kubatsira kuderedza mutoro wekutarisira kwehutano mune ramangwana. Nenzira iyo, kubhadhara mari yakawanda mberi kunoratidzika sekutsvaga kwakakodzera.
Hurumende inobhadhara Medicaid
Ngatisakanganwe kuti hurumende dzehurumende dzinopawo mari kune Medicaid. Maitiro avanoita izvi zvakasiyana kubva kuhurumende kusvika kune hurumende, asi iyo yakawanda inobatsira inobatsira sei rubatsiro rwavanowana kubva kuhurumende yehurumende. Ichokwadi ndechekuti hurumende yehurumende kana hurumende inogona kukwanisa kubhadharira Medicaid pachayo. Vose pamwe chete vanogona kuisa pfuma yakakwana yekuchengeta mamiriyoni evanhu vari kushaiwa.
> Sources:
> Affordable Care Act Medicaid Kuwedzerwa. National Conference of State Legislatures website. http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx. Yakapedzwa musi waDecember 1, 2016.
> Clemans-Cope L, Holahan J, Garfield R. Medicaid Kuwedzera Kukura Kuenzaniswa Nevamwe Vatengi: Kutarisa Uhupupu. Henry Kaiser J. Family Foundation. http://kff.org/report-section/medicaid-spending-growth-compared-to-other-payers-issue-brief/. Yakabudiswa musi waApril 13, 2016.
> Ellison A. Kuvharwa kwechipatara 21 muna 2016. Becker's Hospital Review. http://www.beckershospitalreview.com/finance/21-hospital-closures-in-2016.html. Yakabudiswa naJanuary 6, 2017.
> FY2017 Hurumende yeHurumende yeMubatsiro Mazana. Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services website. https://aspe.hhs.gov/basic-report/fy2017-federal-medical-assistance-percentages. Yakabudiswa naJanuary 13, 2016.
> Mitchell A. Medicaid Isingaenzaniswi Igovera Chipatara Mari. Congressional Research Service. https://fas.org/sgp/crs/misc/R42865.pdf. Yakabudiswa naJune 17, 2016.