Madera sangathe kupeza Medicaid popanda thandizo la federal
Tisanayambe kukambirana za momwe tingasinthire Medicaid , tifunika kumvetsetsa momwe boma la federal likugwiritsira ntchito pulogalamuyo. Pali kusiyana kwa ndalama zogwirizana ndi ngati boma likugwira nawo ntchito kuwonjezereka kwa Medicaid pansi pa Affordable Care Act, aka Obamacare .
Boma la federal linapereka ndalama zowonjezereka zowonjezereka kuti zikuwonjezeredwa ndi Medicaid, kupereka ndalama zokwana 100 peresenti ya ndalama za Medicaid zowonjezera kudutsa mu 2016 ndi 90 peresenti ya izo zimadutsa chaka cha 2020.
Onse akunena, kaya akugwira nawo ntchito kuwonjezeka kwa Medicaid kapena ayi, adapitiliza kulandira ndalama kuchokera ku federal kuchokera ku magulu atatu awa: Kugawidwa kwa Chipatala Chosavomerezeka (DSH), Malipiro a Federal Medical Assistance (FMAP), ndi Maphatikizidwe Ogwirizana Owonjezereka.
Kulipira Malipiro a Chipatala mosiyana
Medicaid sichidziwika bwino chifukwa chokhala wowolowa manja popereka chithandizo chaumoyo. Malinga ndi deta yochokera ku 2005 Medical Expenditure Panel Survey, ndalama zogwiritsira ntchito zaumoyo zimakhala kuti ndi 26 peresenti yapamwamba kwa munthu wamkulu yemwe ali ndi inshuwaransi yaumwini kusiyana ndi munthu wina pa Medicaid omwe ali ndi chithandizo chomwecho.
Mzipatala zomwe zimasamalira anthu ambiri pa Medicaid kapena anthu omwe sali otsimikiziridwa, pamapeto pake amalipidwa mocheperapo kuposa malo omwe amapita kumadera kumene kuli anthu ambiri omwe amadziwika ndi inshuwaransi yapadera. Mu 2016 okha, zipatala 21 zinatseka zitseko zawo kuti zisamalire ana chifukwa cha kuchepa kwa ndalama zochepa komanso mavuto ena azachuma.
Ngakhale kutuluka masewerawa, malipiro osagwiritsidwa ntchito omwe amalephera kugawa (DSH) anayamba kugwira ntchito. Ndalama zowonjezera za boma zimaperekedwa ku maiko kuti azigawa pakati pa zipatala zoyenera zomwe zimawona chiwerengero chosawerengeka cha anthu omwe alibe inshuwaransi. Lingaliro linali kuchepetsa ndalama zolipirira ndalama ku malowa kuti apitirize kusamalira anthu omwe ali ndi ndalama zochepa.
Zolemba zosiyana zimagwiritsidwa ntchito kuwerengera ndalama za federal DSH ku boma lililonse. Njirazi zimaganiziranso ntchito ya DSH ya chaka chatha, kuchepa kwa mitengo, ndi chiwerengero cha anthu omwe akudwala matenda osachiritsika omwe akudwala matendawa. Malipiro a DSH sangathe kupitirira 12 peresenti ya ndalama zonse za boma za Medicaid zothandizira kuchipatala chaka chilichonse.
Mapepala othandizira a Medical Aid
Mapepala othandizira azachipatala a federal (FMAP) adzakhalabe gwero lalikulu la ndalama za Medicaid. Lingaliro losavuta. Pa $ 1 a boma lirilonse lilipereka Medicaid, boma la federal likulimbana ndi 100 peresenti, ie dola ya dola. Dziko loperekera kwambiri likuphimba anthu, ndiwowolowa manja boma la federal liyenera kukhala. Palibe kapu, ndipo ndalama zowonjezera zikuwonjezeka malinga ndi zosowa za dziko.
Mukamaganizira za izo, FMAP ndi wowolowa manja koma sizingakhale bwino kunena kuti amakhala ndi ndalama zochepa poyerekeza ndi mayiko omwe ali ndi ndalama zambiri. Mwachindunji, pangakhale phokoso lowonjezeka lomwe likutanthauza kuti anthu omwe ali osauka ndi olemera kwambiri, ndipo FMAP ikhoza kupereka malipiro ochepa poyerekeza ndi zosowa zachuma.
Pofuna kuthetsa vutoli, Social Security Act inakhazikitsa ndondomeko yowerengera ndalama za FMAP pogwiritsa ntchito ndalama zomwe boma limapereka poyerekeza ndi chiwerengero cha dziko. Ngakhale kuti boma lirilonse limalandira pafupifupi FM peresenti ya 50 peresenti (boma la federal limalipira 50 peresenti ya Medicaid mtengo, mwachitsanzo $ 1 ya $ 1 yomwe idaperekedwa ndi boma), mayiko ena adzalandira zoposa.
Ku Alaska, California, Connecticut, Maryland, Massachusetts , Minnesota, New Hampshire, New Jersey, New York, North Dakota, Virginia, Washington, ndi Wyoming ndizo zokha mu 2017 kukhala ndi FMAP ya 50 peresenti. Maiko ena onse amalandira ndalama zoposa za Medicaid ndalama kuchokera ku boma la federal.
Mwachidziŵikire, Mississippi ali ndi malipiro apamwamba kwambiri omwe amapeza ndalama ndi 2017 FMAP ya 74.63 peresenti. Izi zikutanthauza kuti boma limapereka ndalama zokwana 74.63 peresenti ya ndalama za Medicaid, zomwe zimapereka madola 2.94 pa $ 1 yomwe boma likugwiritsa ntchito.
Zowonjezera Zowonjezera
Mapulogalamu othandizira ali ofanana ndi FMAP koma atengedwa chimodzimodzi patsogolo. Amachulukitsa kuchuluka kwa ndalama zomwe boma la federal likupereka pazinthu zina. Mapulogalamuwa akuphatikizapo koma sali ochepa kwa:
- Matenda a khansa ya pachifuwa ndi chiberekero (amaperekedwa pa chiwongoladzanja cha CHIP FMAP *)
- Ntchito zothandizira za kulera (zolipira pa FMAP za 90 peresenti)
- Ntchito zaumoyo zapakhomo (zaperekedwa pa FMAP za 90 peresenti)
- Ntchito zothandizira anthu akuluakulu (kulipira pa FMAP + 1 peresenti ya boma)
* CHIP ndi Pulogalamu ya Inshuwalansi ya Ana
Mapulogalamuwa amawoneka ngati ofunikira chifukwa angathandize kuchepetsa kulemedwa kwa ndalama zothandizira zaumoyo m'tsogolomu. Mwanjira imeneyo, kupereka ndalama zambiri patsogolo kumayesedwa ngati ndalama zoyenera.
Zothandizira Boma kwa Medicaid
Tisaiwale kuti maboma a boma amaperekanso ndalama ku Medicaid. Momwe amachitira zimenezi zimasiyanasiyana kuchokera ku boma kupita ku boma, koma kuchuluka kwawo kumakhudza momwe amathandizira kuchokera ku boma la federal. Chowonadi n'chakuti boma la federal kapena boma lingathe kulipirira Medicaid palokha. Ndi pokha pokha omwe angathe kugawa zinthu zokwanira kuti asamalire anthu mamiliyoni ambiri omwe akusowa thandizo.
> Zotsatira:
> Zosamalidwa bwino zothandizira kuwonjezereka kwa mankhwala. Msonkhano Wadziko Lonse wa Malamulo a boma. http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx. Idasinthidwa pa December 1, 2016.
> Clemans-Cope L, Holahan J, Garfield R. Medicaid Kuwononga Ndalama Poyerekeza ndi Obwezera Ena: Kuwona Umboni. Henry Kaiser J. Family Foundation. http://kff.org/report-section/medicaid-spending-growth-compared-to-other-payers-issue-brief/. Lofalitsidwa pa April 13, 2016.
> Ellison A. Kuikidwa kwa chipatala 21 mu 2016. Kukambitsirana kwa Hospital Becker. http://www.beckershospitalreview.com/finance/21-hospital-closures-in-2016.html. Lofalitsidwa pa January 6, 2017.
> FY2017 Maphwando a Federal Medical Assistance Percentage. Ofesi Yothandizira Wotsogolera Kukonza ndi Kufufuza, webusaiti ya US Health and Human Services webusaitiyi. https://aspe.hhs.gov/basic-report/fy2017-federal-medical-assistance-percentages. Idasindikizidwa pa January 13, 2016.
> Mitchell A. Medicaid Yopanda malire Gawani Malipiro a Chipatala. Congressional Research Service. https://fas.org/sgp/crs/misc/R42865.pdf. Idasindikizidwa pa June 17, 2016.