Momwe Mayiko amagwiritsira ntchito Medicaid Waivers Kuti Akonzekere Mapulogalamu Awo Omwe Amagwiritsira Ntchito Medicaid
Medicaid imalandiridwa limodzi ndi boma la federal ndi boma la boma, kuthandiza anthu ndi mabanja omwe ali ndi ndalama zochepa zothandizira inshuwalansi komanso omwe chithandizo chamankhwala chingakhale cholemetsa chachuma. Medicaid imayang'aniridwa ndi boma lirilonse, ndipo malamulo oyenerera amasiyana ndi boma ndi dziko.
Waiver ya Medicaid imalola mayiko kuti ayesere ndikupanga njira zomwe zimaperekera malingaliro awo a Medicaid omwe amapereka ndalama zomwe zimasiyana ndi dongosolo la federal.
Mapulogalamuwa akhoza kukhala ndi zofunikira zokhazokha, kapena mapulogalamu angagwire ntchito ngati mabungwe osamalira osamalira. Mwachitsanzo, mapulogalamu a Medicaid angapangidwe kwa anthu omwe akusowa thandizo, monga okalamba kapena amayi oyembekezera.
Ku United States, Medicaid ndi chithandizo chachikulu chomwe chimapereka ndalama zothandizira anthu pazithandizo zachipatala komanso zaumoyo za anthu osauka. Ngakhale kuti tsopano mayiko onse akuvomereza ndalama za Medicaid ndipo ali ndi mapulogalamu awo a Medicaid , mapulogalamuwa amasiyana. Kuwonjezera pa kukwanitsa kugwiritsa ntchito zofuna za Medicaid, mayiko angathenso "kutuluka" kulandira ndalama zatsopano za Medicaid ndi zofunikira.
Mipukutu imatha kugwiritsidwa ntchito ku Bungwe la Inshuwalansi ya zaumoyo ya Ana (CHIP), yomwe imapereka ndalama za boma kuti zigwirizane ndi ndalama za boma zothandizira ana omwe sali ovomerezeka ndi mabanja omwe alibe ndalama koma sangathe kukwaniritsa zofunikira za Medicaid.
Medicaid Waivers
Zotsalira za Medicaid zingapite ndi mayina osiyanasiyana.
Mayinawa akuphatikizapo maofesi 1115 omwe amavomerezedwa ndi Gawo 1115 la Social Security Act, omwe amalembedwa mu 1915 (omwe amavomereza gawo la 1915 la Social Security Act), mautumiki operekera msonkho, mapulogalamu opereka ndalama, mapulogalamu oletsedwa, Home ndi Community Based Services (HCBS). mayina osiyana ndi mayiko ena enieni.
Pali mitundu yambiri ya kuchotsedwa kwa Medicaid, ngakhale kuti ili pansi pa ulamuliro wa Gawo 1115 ndi 1915 la Social Security Act:
- Gawo 1115 zopereka ndalama zimapereka polojekiti ndi kafukufuku omwe akukonzedwa kuti ayesetse kukwanira koyenera kapena njira zowonjezeredwa, komanso njira zopezera ndalama ndi kupereka Medicaid. Gawo 1115 kuchoka pamaboma kumalola kuti "oyendetsa ndege" kapena "mawonetseredwe" mapulojekiti omwe akuyenera kulimbikitsa kapena kulimbikitsa kulumikiza ndi kuyenera. Powonjezereka kwa Medicaid pansi pa Affordable Care Act, maofesi 1115 akhala otchuka kwambiri monga mayiko akuyang'ana njira zosiyana zogwiritsira ntchito Medicaid kukulitsa ndikugwiritsa ntchito ndalama zowonjezera za federal zomwe zafika ku mayiko kuti athe kufalitsa mwayi wopeza chithandizo. Kuti chivomerezedwe, chigawo cha Gawo 1115 chiyenera kukhala chisankho chosalowerera boma la federal (mwachitsanzo, boma la federal silingathe kuchita zambiri pamalo moperekera malire).
- Gawo 1915 (b) kuchotsa maboma kumalola mayiko kukhazikitsa ndondomeko yosamalira ma Medicaid. Mabungwe a State Medicaid angagwirizane ndi mabungwe omwe amasamalidwa (MCOs) kuti athandize kusamalira khalidwe, kugwiritsa ntchito, ndi ndalama, komanso akugwira ntchito pofuna kukonza mapulani komanso zotsatira za odwala. MCOs amapereka chithandizo chaumoyo kwa opindula a Medicaid ndipo amalandira malipiro a mautumikiwa kuchokera ku ndalama za boma za Medicaid.
- Gawo 1915 (c) Oletsera a kunyumba ndi a m'midzi (HCBS) amawathandiza kuti alandire chithandizo chamankhwala kwa nthawi yaitali kunyumba kapena m'madera omwe amakhala nawo m'malo osungirako malo, monga nyumba zaukhondo . Maboma Achimereka Achimereka angagwirizane ndi mayiko kuti azilamulira 1915 (c) kuchotsa ntchito kudzera ku Indian Health Services. M'dziko la HCBS, mayiko angathenso kupereka 1915 (i) ndi 1915 (j) kuchotsa, ndi 1915 (k) kuchotsa, zomwe zonse zimapereka chisinthiko choonjezera kupereka HCBS kwa anthu oyenerera.
- Gawo 1915 (b) ndi 1915 (c) kuchotsa boma limapereka boma kuti lizipereka chithandizo chomwe chili mu Gawo 1915 (c) pochita mgwirizano ndi mabungwe osamalira omwe akufotokozedwa mu Gawo 1915 (b). Mabungwe omwe amatha kusamalira omwe amagwirizana nawo amapereka thandizo la chithandizo chamankhwala kunyumba ndi kumidzi.
Malamulo ndi Njira Yavomereza Yowonjezera
Mtundu uliwonse wa Medicaid waiver uli ndi malamulo osiyanasiyana omwe amagwiritsidwa ntchito. Tsambali lili ndi chidule cha zosiyana siyana, momwe amagwiritsidwira ntchito, ndi zofunikira zomwe zimagwiritsidwa ntchito kwa aliyense.
Mndandanda wa zowonongeka za Medicaid zomwe zikuvomerezedwa ndi zomwe zikuyembekezeka zikupezeka pa webusaiti ya Medicaid. Zomwe boma limapereka zimayesedwa ndi kuvomerezedwa (kapena kukanidwa) pazomwe zilipo. Chigawo cha 1115 chotsatira chimavomerezedwa kwa zaka zisanu poyamba, ndi zaka zitatu zatsopano. Chigawo cha 1915 chotsatira chiyenera kuvomerezedwa kwa zaka ziwiri, koma nthawi zina, akhoza kuvomerezedwa kwa zaka zisanu.
Kodi Chisamaliro Chachikulu ndi Zapanokha ndi Zogwira Ntchito Zogwira Ntchito Zotani?
Kwa anthu omwe amafunikira chisamaliro cha nthawi yaitali, monga okalamba, Medicaid amathandiza kulipira chisamaliro ichi m'mabungwe, monga nyumba za okalamba. Izi sizingakhale zotheka nthawi zonse kapena zothandiza kwa wopindula, komabe. Gawo 1915 la Medicaid (c) Zopereka zapakhomo ndi kumudzi zimapereka chithandizo kwa anthu omwe sakhala m'mabanja okalamba. Ophandizira akhoza kukhala m'nyumba zawo, kapena amakhala ndi achibale awo kapena othandizira ena, kapena pakhomo lapadera lokhalamo kapena kumalo osungirako okalamba komanso m'madera ena osati nyumba zawo kapena nyumba za okalamba.
Medicaid "Sankhani"
Kuwonjezera pa kuchotsa ntchito kuti pakhale ndondomeko yapadera ya Medicaid, mayiko angasankhe "kusankha" kunja kwa ndalama zina za Medicaid koma adakalibe ndalama zakhazikitsidwa kale.
The Affordable Care Act ikupereka ndalama zowonjezereka kwa Medicaid kwa mabanja osauka kwambiri, ndipo olemba malamulo akufuna kuti avomereze kuti ndalamazo zivomerezedwe, ndipo maboma sangathe kusunga ndalama zawo za Medicaid ngati sakuvomereza ndalama za Medicaid. Koma Khoti Lalikululikulu likulamulira mu 2012 lomwe limati sitingakakamize kuvomereza ndalama zatsopano (ndipo kenaka, tifunikira gawo la boma la kuwonjezeka kwa Medicaid, lomwe potsiriza lidzakhala 10 peresenti ya chiwerengero), ndi kukana Medicaid ndalama zowonjezera sizingatheke kuti boma liwononge ndalama zomwe zilipo Medicaid.
Chifukwa chake, pali mayiko 19 omwe sanatulutse Medicaid, koma iwo akupitiriza kulandira ndalama zawo zisanayambe kupezeka ku Medicaid.
> Zotsatira:
> Magulu a Medicare ndi Medicaid Services. Kusanthula kwa dziko lonse ka 1915 (c) HCBS Waivers.
> Medicaid.gov. Pafupi ndi Gawo la 1115 Zisonyezero.
> Medicaid.gov. Magulu oyenerera a Medicaid ndi CHIP. June 2016.
> Medicaid.gov. Mndandanda wa Waivers State.