Sidee bay kuu saameynayaan?
Medicaid waxaa la abuuray Medicare sannadkii 1965. Inkasta oo Medicare loogu talagalay inay bixiso daryeel caafimaad oo loogu talagalay dadka waayeelka ah, himilada Medicaid waxay ahayd inay bixiso daryeel dadka aan awood u lahayn - kuwa dakhligoodu hooseeyo, laxaad la'aanta, ama labadaba. Dadka qaar ayaa xitaa xaq u yeelan kara labada barnaamijba .
Medicaid ayaa isbeddel ku samaysay sanadihii ugu dambeeyay, gaar ahaanna Xeerka Daryeelka Lacagta La-Beddelayo 2010, oo loo yaqaan 'Obamacare'.
Laga bilaabo 2014, goboladu waxay doorteen inay qaataan maalgalin dheeraad ah oo federaal ah muddada gaaban illaa sannadka 2020 si loo dabagalo ballaarinta Medicaid . Hadda, waxay u muuqataa in is-beddelaad badan oo is-beddel ah ay iman karto.
Bishii Janaayo 11, 2018, Xarumaha Adeegyada Medicare iyo Adeegyada Medicaid, oo hoos timaada madaxa CMS Seema Vera, ayaa ku dhiirrigelisay dawladaha inay dejiyaan barnaamijyo tijaabo ah oo soo rogay shuruudaha tababarka shaqada ama tababarka shaqada ee dadka qaata Medicaid. Hadafka, waxay sheeganeysaa, inay tahay hagaajinta tayada nolosha dadka ee ku jira Medicaid. Dawladuhu waxay soo jeedin karaan codsiyadooda iyaga oo dhaafaya, laakiin waa inay helaan ansixinta federaalka.
Arrintani waa mid aad u adag marka loo eego CMS oo kuu horseedaya inaad rumaysato.
Shaqada iyo fayoqabka
Dhammaan suurtogalka, arrintani way ka yar tahay caafimaadka iyo ladnaanta marka loo eego qiyaastii doolar iyo cents. Dhammaantii, maamulka Trump wuxuu isku dayay in uu ka gooyo boqollaal milyan oo doolar oo ka timaadda Medicaid sanadka 2017 iyada oo ay ku guuldareysatay Sharciga Caafimaadka Daryeelka Caafimaadka / Sharciga Dib u Heshiiska Daryeelka Wanaagsan.
Intii lagu bedeli lahaa kharashka dawlad-goboleedyada, sharcigu wuxuu isticmaali lahaa deeq-lacageed ama xaddidaad dakhli ah si loogu maal-galiyo barnaamijyada Medicaid. Gobolada intooda badani way awoodi kari waayaan inay yaraadaan oo ay u baahdaan inay yareeyaan dheefaha, abuuraan liisaska sugitaanka, waxay u baahan yihiin dadka inay bixiyaan caymiska, ama ay ku soo rogaan isbeddelada kale ee kharashka.
Jamhuuriyeyaashu waxay caddeeyeen in ay doonayaan in ay dib u habeeyaan Medicaid ee 2018. Shuruudaha shaqada ayaa ah talaabada koowaad ee ujeeddadaas. Shuruudahan waxaa laga filayaa in ay yareeyaan tirada dadka uqalma barnaamijka Medicaid iyo in la yareeyo diiwaangelinta guud ee barnaamijka. Saameynta guud waxay noqon doontaa in la yareeyo kharashka Medicaid iyo in lagu wareejiyo qorshayaasha caafimaadka ee loo-shaqeeyaha.
Ma jirto daraasado lagu muujinayo in shaqeyntu ay hagaajineyso tayada nolosha. Si lid ku ah, waxaa jira daraasado muujinaya in fiditaanka Medicaid ay hagaajisay natiijooyinka caafimaad iyo ka qayb qaadashada bulshada.
Daraasadda 2015 ee joornaalka PLoS One marka la barbar dhigo in ka badan 16,000 dadka qaangaarka ah ee hooseeya ee gobolada leh iyada oo aan lahayn ballaarinta Medicaid. Cilmi baadhayaashu waxay ogaadeen in uunan ahayn dadka dakhligoodu hooseeyo ay u badan tahay inay noqdaan kuwo madow ama degaan miyi ah, laakiin waxay sidoo kale ay u badan tahay inay helaan natiijooyin caafimaad oo ka sii wanaagsan haddii ay ku noolyihiin gobolo ay lahaayeen ballaarinta Medicaid.
Marka ay timaado kaqeybgalka beesha, waxay sheegaysaa ballaarinta Medicaid waxay muujisay korodhka tabarucida dadka ka soo qaada Medicaid. Tani waxay muujineysaa daraasad cilmiyeedka 2017 ee joornaalka Socius. Haddii tabaruciddu ay ahayd mid rasmi ah iyada oo loo marayo urur ama aan rasmi ahayn xaafadaha, qiimaha ayaa si wayn kor ugu kacay, gaar ahaan kooxaha laga tirada badan yahay.
Dadka Maraykanku Able-Weyn iyo Shuruudaha Shaqada ee Medicaid
Sannadka 2016, 72,2 milyan oo qof ayaa ku jiray barnaamijka. Guud ahaan, inta badan dadka qaata Medicaid waa carruur. Marka laga reebo carruurta, dadka da'da ah, iyo dadka ku jira Dakhliga Kabitaanka Dakhliga (SSI), 24.6 milyan oo qaangaar ayaa weli ah.
Kooxdan, boqolkiiba 60 (14.8 milyan) ayaa shaqaynaya-42 boqolkiiba waqti buuxa (ugu yaraan 35 saacadood toddobaadkii) iyo 18 boqolkiiba waqti dhiman. Kuwa aan shaqeynin (9.8 milyan), boqolkiiba 14 waxay leeyihiin xanuun ama naafonimo, 12 boqolkiiba ayaa ku lug leh xanaanaynta, 6 boqolkiiba waxay joogaan dugsiga, boqolkiiba 7na ma shaqeeyaan sababo kale.
CMS waxay si gaar ah u sheegaysaa in shuruudaha shaqada ay tahay in loo tixgeliyo kaliya musharrixiinta awoodda u leh, laakiin ma qeexaan waxa macneheedu yahay.
Dadka u qalma Caymiska Naafada ee Lambarka Bulshada (SSDI) ayaa sidoo kale u qalma Medicaid. Si kastaba ha noqotee, naafanimada la aqoonsan yahay barnaamijyadani ma ahan mid sahlan. Shuruudaha waa adag tahay, inta badanna waa la diidi karaa. Sanadkii 2010, kaliya 34.8% codsiyada 2,838,485 ayaa la ansixiyey, hoos uga dhacay min 56.1 boqolkiiba sannadkii 2000. Dhab ahaantii, tirada oggolaanshaha ayaa hoos u dhacay sanadkiiba tan iyo 2005tii. Taasi waxay ka baxaysaa dad badan oo qaba naafonimo iyada oo aan la garanayn curyaan.
Gobol kasta wuxuu u baahan doonaa inuu dejiyo tilmaamo u gaar ah waxa uu u arko inuu yahay "karti leh". Tusaale ahaan, Kentucky, waa kan ugu horreeya oo kaliya oo leh shuruudaha shaqada looga baahan yahay, oo la aqoonsan yahay, wuxuu aqoonsadaa dadka qaba kansarka, xanuunka dhiig-xinjirowga, ama khamriga ama khalkhalka maandooriyaha sida "caafimaad ahaan jilicsan."
Ku qanacsanaanta shuruudaha shaqada ee Medicaid
Marka laga eego shuruudaha shaqada, Kentucky iyo sagaal gobol oo kale waxay codsadeen in la dhaafo. Arkansas, Kentucky iyo Wisconsin waxay ubaahanyihiin 80 saacadood oo shaqo ah bishiiba; Indiana ilaa 20 saacadood toddobaadkii; Arizona, Maine, iyo Mississippi 20 saacadood oo shaqo todobaadkii; Kansas iyo New Hampshire 20 ilaa 30 saacadood toddobaadkii; iyo Utah saddex bilood oo xiriir ah oo shaqo raadin / tababar ah ilaa ay shaqeeyaan 30 saacadood toddobaadkii.
Maxaa ka dhigan "shaqada" ayaa sidoo kale ku kala duwan gobolka. Waxqabadyadu waxay kala duwan yihiin shaqo-siinta tabarucidda. Kani waa burburinta iyadoo loo eegayo codsigga dhaafitaanka Medicaid ee gobol kasta.
- Daryeelka qof aan ku-tiirsane leh xaalad caafimaad oo naafo ah - Kentucky
- Daaweynta daroogada - Kentucky
- Waxbarashada - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire
- Shaqada - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi, New Hampshire, Utah, Wisconsin
- Shaqo raadinta - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, New Hampshire, Utah
- Tababarka Shaqada - Arkansas, Indiana, Kansas, Kentucky, Mississippi, New Hampshire, Utah, Wisconsin
- Tabarucidda - Arkansas, Arizona, Indiana, Kansas, Kentucky, Maine, Mississippi
Ka-dhaafitaanada Ka-Baxsanaanta Shaqada Medicaid
Ma aha qof kasta inuu la kulmo shuruuda shaqada ee Medicaid. Gobol kasta ee codsanaya ka-dhaafitaan wuxuu sheegaa qofka ka reeban shuruudaha. Qeyb kasta oo ka reeban, gobolku wuxuu u baahan karaa shuruudaha kala duwan.
Ka dhaafida ugu badan waa da '. Dhamaan dawladuhu waxay raali ka yihiin qof kasta 65 sano iyo ka weyn shuruudaha shaqadan. Gobolada qaarkood waxay u ogolaanayaan dabacsanaan dheeraad ah. Arkansas iyo Wisconsin way ka reebeen dadka 50 sano iyo ka yar; Arizona 55 sano iyo ka yar; iyo Indiana iyo Utah 60 sano iyo ka yar.
Daryeelidda carruurta 6 sano iyo ka yar ama ilmaha ilmo curyaamiinta ah ama dadka qaangaarka ah ayaa guud ahaan ka dhigaya hal dhibane. Qaar ka mid ah goboladu waxay u kordhin karaan tan carruurta waaweyn iyo xataa xannaaneyn korinta. Koonfurta Kentucky, kaliya hal qof oo qoyskiiba ayaa ka reeban haddii ay daryeesho ilmo yar oo ku-tiirsan ama qof weyn oo naafo ah.
Inkastoo saacadaha lagu qaato daaweynta daroogada ay buuxinayaan shuruudaha shaqada ee Kentucky, waxaa loo tixgelinayaa in laga reebo Arkansas, Indiana, Maine, Mississippi, New Hampshire, Utah, iyo Wisconsin. Ardayda waxaa sidoo kale laga reebay shuruudaha. Si kastaba ha noqotee, da'da ardayga iyo tirada saacadaha iskuulka ayaa laga yaabaa inay ciyaaraan. Inaad qaadato gunnada shaqo la'aanta waxay kaa dhigi kartaa in lagaa dhaafo Maine, Utah, iyo Wisconsin balse aan ku jirin gobollada kale ee codsan waayey.
Si xiiso leh, Kentucky wuxuu ku daray hab cusub oo loogu talagalay dadka aan si kale u buuxin shuruudaha shaqada, koorsada caafimaadka iyo dhaqaalaha. Ku dariddu waxay kordhisay welwelka. Waxaa laga yaabaa in si daacadnimo ah loola macaamili karo dadka aan si fiican u qorin luqadda qoran ama afka lagu hadlo. Waxa kale oo ay ku adkaan kartaa dadka in ay dhammaystiraan haddii aysan dhammaysan waxbarashada aasaasiga ah.
Doodda ku saabsan Shuruudaha Shaqada ee Medicaid
Kuwa taageeraya shuruudaha shaqada ee Medicaid waxay xoogga saarayaan sida ay u kaydin doonto lacagta gobolka. Ka soo horjeeda GOP mucaaradka Sharciga Daryeelka La Yiqiin karo, shuruudaha shaqooyinkaas waxaa laga yaabaa inay yeeshaan natiijo aan loo baahneyn oo lagu xoojinayo. Laga soo bilaabo Jannaayo 2018, kaliya 33 dawladood, oo ay ku jirto Degmada Columbia, ayaa soo jiidatay ballaarinta Medicaid. Raadinta shuruudaha shaqada ee macnaheedu yahay in la yareeyo qarashka barnaamijka, gobolo badan - Idaho, Kansas, Waqooyiga Carolina, Utah, Virginia, iyo Wyoming-waxay hadda eegayaan in ay ballaadhiyaan.
Inkasta oo Kentucky la filayo in ay $ 2.4 bilyan ku bixiso Kharashka Medicaid muddo shan sano ah, hadana waxa la filayaa in 95,000 qof ay lumiyaan caymiskooda caafimaadka. Xeerka dacwada fasalka waxaa lagu fayl gareeyay maxkamad federaali ah oo ah Jan. 24 ilaa 16 dadka qaata Medicaid ee Kentucky. Waxay sheeganayaan shuruudaha shaqada inay beddelaan ujeedada loogu talo galay ee Medicaid oo ah inay bixiso daryeelka caafimaadka saboolka.
Waxaa dhici karta inay jiraan dacwado gobolo kale haddii xukuumada federaalku ogolaato ka dhaafida Medicaid kale. Natiijooyinka dacwada waxay saameyn kartaa mustaqbalka Medicaid. Guul waxaa ay u adkeyn kartaa maamulka hadda jira in ay sii wataan dib-u-habeynkii Medicaid iyada oo khasaaro ay u suura galin karto in isbaddalo badan lagu sameeyo barnaamijka mustaqbalka dhow.
Ereyga
Medicaid waxay ku saabsan tahay in la maro isbedel weyn. Laga bilaabo 2018, goboladu waxay codsan karaan inay ku daraan shuruudaha shaqada ee barnaamijyada Medicaid. Ilaa hadda, toban dawladood ayaa dalbaday, gobolka Kentucky, ayaa la ansixiyay isbeddelka is-qoritaan ee ugu horeeyay ee la qabto bisha Luulyo.
Inkastoo dadka qaar laga yaabo inay ka dhaafaan shuruudahan shaqada ee ku salaysan da'da, xanaaneynta, naafada, ama in ay noqoto arday firfircoon, dad badan maahan. Haddii aad tahay ama aad tahay ama aad ka soo horjeedo shuruudaha shaqada ee Medicaid, gobolo badan ayaa laga yaabaa inay doortaan inay kordhiyaan Medicaid.
> Ilo:
> Han X, Nguyen BT, Drope J, Jemal A. Natiijooyinka Caafimaad ee La Xiriira Xaaladda: Dhaqdhaqaaqa Medicaid iyo Hawlaha aan Laysu ekeynin Midkood. 2015 Dec 31; 10 (12): e0144429. doi: 10.1371 / journal.pone.0144429.
> Mager-Mardeusz H, Lenz C, Kominski GF. "Cap" oo ku saabsan Medicaid: Sidee Deeqaha Block, Cap Capap, iyo Capped Allotments Might Fundamentally Isbedel Nabadgelyada Nabadgelyada. Warbixinta Siyaasadda UCLA Cent Siyaasadda Caafimaad 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 iyo Shuruudaha Shaqada: Hagaha Cusub, Faahfaahinta Gobolka Waiver iyo Arrimaha Muhiimka. Henry J. Kaiser Foundation Foundation. https://www.kff.org/medicaid/issue-brief/medicaid-and-work-requirements-new-guidance-state-waiver-details-and-key-issues/. La daabacay Janaayo 16, 2018.
> SMD: 18-002, Fursadaha Horumarinta Shaqada iyo Ka Qeybgalka Bulshada ee Ka-faa'idaystayaasha Medicaid. Xarumaha adeegyada Medicare iyo Medicaid. https://www.medicaid.gov/federal-policy-guidance/downloads/smd18002.pdf. La daabacay Janaayo 11, 2018.
> Sohn H, Timmermans S. Saamaynta Dhaqan ee Dib-u-habeyn Caafimaad Caafimaad: Baaxadda Medicaid ee Sharciga Daryeelka La-Beddelayo iyo Isbedelka Tabarucidda. Socius. 2017 Jan-Diseembar 3. doi: 10.1177 / 2378023117700903. Epub March 24, 2017.