Tsayawa Yarar Yammacin Yara lafiya
Dukansu Medicaid da Shirin Kula da Lafiya na Yara (CHIP) suna samar da lafiyar marasa lafiya ga yara. Dukansu shirye-shiryen biyu suna haɗaka da haɗin gwiwar gwamnatocin tarayya da jihohi. Dukansu suna gudana daga jihohi.
Har ila yau akwai wasu bambancin da ke tsakaninsu tsakanin shirye-shiryen biyu da kake bukata don ganewa idan kana da yaron da ke buƙatar kulawa. Sakamakon haka, ya dogara ne akan abin da kake zaune a ciki.
Maimakon Medicaid ga Yara
Yara da aka haifa a cikin iyalan da ke samun kashi 133 ko fiye da matakin talauci na tarayya (FPL) a kowace shekara sun cancanci Medicaid. FPL na lissafi ne ta Ma'aikatar Kiwon Lafiya ta Amurka da Ayyukan Harkokin Kiwon Lafiya a kowace shekara kuma yana dogara ne akan yawan mutanen da ke cikin iyali tare da la'akari da aka ba su wuri. Bayan haka, wasu jihohi sun fi tsada fiye da wasu, alal misali Alaska da Hawaii.
Kafin Dokar Kulawa ta Kasa (ACA) ta wuce a shekara ta 2010, yara sun cancanci Medicaid bisa la'akari da shekarunsu da kuma biyan kuɗi na iyali. Yawancin magana, tsofaffi yaro ya sami, ƙananan zai iya samun magani na Medicaid don samun kudin iyali daya. Babu shakka, wannan yana nufin cewa kawai wasu yara a cikin iyali ɗaya zasu iya rufe a kowace shekara. Sabuwar dokar ta sanya daidaitattun kudin shiga daidai ga yara 0 zuwa 19.
Wasu jihohin suna da nau'ikan bukatun daban-daban na kungiyoyi daban-daban, amma yanzu an ƙayyade darajar daidai don akalla kashi 133 na FPL ga dukan yara. Kafin ACA, an kafa ƙofar kujerun a kashi 100 kawai na yara tsakanin shekarun 6 zuwa 19.
Yiwuwa don CHIP
Ana nufin Medicaid don samar da kulawa ga yara masu talauci.
An kafa shirin CHIP a shekarar 1997 a matsayin wata hanya ta fadada ɗaukar hoto ga yara waɗanda ke da albashin iyalin ƙasa amma waɗanda suka fada a waje da madogarar magani na Medicaid.
Ƙasashen na yanke shawarar ƙayyadaddun ƙofofin ga CHIP, amma mafi yawan jihohin (jihohi 46 da Gundumar Columbia) sun kafa wannan kofa a 200% na FPL ko fiye.
Tarayya Tarayyar Medicaid
Lokacin da ya zo Medicaid, gwamnatin tarayya ta dace da bayar da kuɗin "dollar don dollar," a kalla a cikin ra'ayi. Yana amfani da abin da aka sani da Asusun Taimakon Gida na Tarayya (FMAP) don tantance yawan zai biya. FMAPs suna la'akari da matsakaicin yawan kudin da ake samu a cikin ƙasa da matsakaicin ƙasa.
Kowace jihohi an ba FMAP na akalla kashi 50, watau gwamnatin tarayya ta biya kashi 50 na kudaden Medicaid. Duk sauran jihohi suna karɓar yawan adadin magani na Medicaid bisa tushen FMAP. Tare da mafi yawan ƙasƙanci na asalin kuɗi, Mississippi yana da FMAP 2017 na kashi 74.63 domin gwamnatin tarayya ta ba da dala 2.94 na kowane $ 1 jihar na ciyarwa.
Domin samun wannan kudaden magani, jihohi sun yarda da wasu sharuɗɗa. Jihar ba a halatta sanya mutane a jerin jerin jirage ba, baza su iya yin rajista ba, kuma bazai iya cajin kuɗi ko biyan kuɗi ga duk wanda ke samun kashi fiye da 150 na FPL.
Tarayyar Tarayya ta CHIP
Kudade na Tarayya na CHIP, a gefe guda, yana da iyakacin ƙaddara. Kowace jihohi an ba da kyauta a shekara mai zuwa a matsayin tallafin asali. Yawan adadin kuɗin da aka ƙayyade ba tare da la'akari da yawan mutanen da shirin ya rufe ba.
Jihohi 50 da Gundumar Columbia suna da zabi don amfani da tallafin su a cikin hanyoyi guda uku:
- A matsayin hade Shirye-shiryen Medicaid-CHIP (shirye-shirye na jihar 29)
- A matsayin ɓangare na fadada maganin Medicaid (jihohi 9)
- A matsayin shirye-shirye na CHIP (shirye-shirye na jihar 13)
Don ƙarfafa jihar don shiga cikin CHIP, gwamnatin tarayya tana ba da karin daidaituwa fiye da yadda yake a Medicaid.
Matsakaicin ƙasa na likitanci na Medicaid shine kashi 57 cikin 100 amma yana da kashi 70 cikin 100 na CHIP. Bugu da ari, jihohi da bukatun tattalin arziki mafi girma za a sake biya su a matsayin mafi girma.
Wadannan jihohi ta amfani da shirye-shiryen hade ko Maɗauri na Medicaid suna da bukatun ka'idojin kamar yadda gargajiya na gargajiya. Ƙasashen da ke tare da shirye-shiryen na CHIP, duk da haka, suna da ɗakin da za a yi amfani da shi. Idan akwai buƙata, za su iya sanya yara a jerin jerin jirage ko kafa ƙididdigar shiga don ƙaddamar da farashin CHIP. Yawancin wadannan jihohin za su cajin kuɗi da kuma biyan kuɗi ga masu amfana.
Differences a Coverage na Medicaid da CHIP
Dokokin Tarayya sun ba da umarnin Medicaid ta ba da sabis na musamman ga 'ya'yanta da aka rufe. Wannan ya haɗa da Shirye-shiryen Farko, Tsarin Gida da Kulawa (EPSDT), ayyuka masu mahimmanci waɗanda ke mayar da hankali kan kulawa da kariya. Ya haɗa da wadannan:
- Binciken tarihin cikakke
- Dental kulawa
- Sauran saurowa, ciki har da haɗin gwaninta da kuma jin daɗi
- Alurar rigakafin rigakafi da maganin rigakafi
- Gudun jagora
- Sanarwar kiwon lafiya da shawara
- Nazarin jiki
- Binciken hangen nesa, ciki har da tabarau
Ayyukan da Medicaid ya rufe sun hada da kulawa a Cibiyoyin Kula da Lafiya na Federally (FQHCs) da kuma ayyuka na gyaran.
Shirye-shirye na CHIP, duk da haka, ba dole ne su bi ka'idar da EPSDT ta kafa ba, ko da yake dole ne su bayar da kulawar kula da kula da asibitocin da suka hada da kula da asibitoci, binciken nazarin gwaje-gwaje, hasken rana, da jarrabawar yara, ciki har da rigakafi. Kiyaye na kulawa bazai iya zama kamar yadda aka bayar a ƙarƙashin EPSDT amma dole ne ya zama ɓangare na kunshin amfani da aka haɗa. Don haka, kowace jihohi za ta iya zaɓar haɓin haɓin haɓin haɓaka bisa ga shirin ƙwararren ƙwararren ƙwararren ma'aikata, wanda ya fi dacewa da shirin likitancin ma'aikatan aikin jinya na ma'aikatan tarayya, ko kuma ɗaukar hoto daga sha'anin inshora na kasuwanci mafi shahara a jihar.
Future na Medicaid da CHIP
Harkokin siyasa, Magungunan Medicaid ne ake zargi. Gwamnatin na yanzu tana ƙoƙari ta sake share Dokar Kulawa mai Kyau, wanda hakan zai kawo ƙarshen fadada Medicaid. Manufar ita ce ta rage yawan kudade na tarayya don Medicaid na gargajiya.
Shirin shirin kiwon lafiyar na GOP na kwanan nan yana so ya maye gurbin matakan tarayya don Medicaid tare da tallafin bashi ga kowace ƙasa. Duk da yake tallafin asusun ba da amfani ga shirin CHIP, shirin na CHIP yana da muhimmanci sosai a sikelin fiye da Medicaid. Har ila yau, toshe ƙayyadaddun ƙididdigar ƙididdigar ƙididdigar yawancin yara na iya rufe a ƙarƙashin CHIP Ƙasashen da takardun tallafi sun sanya yara a jerin jeri.
Yaya yawancin yara zasu rasa kulawar kiwon lafiya idan GOP ta sake farfadowa da lafiya?
Kalma Daga
Yara da aka taso a cikin iyalai marasa kudi suna da nauyin kula da lafiyar su kamar yadda suke samun takwarorinsu masu girma. Medicaid yana kula da iyalan mafiya talauci yayin da CHIP ya shimfiɗa ɗaukar hoto ga yawan ƙananan yara. Kulawa ta hanyar shirin Medicaid na iya zama mafi mahimmanci, amma shirin na CHIP yana ba da cikakken zurfin ɗaukar hoto. Yi la'akari da bambanci tsakanin waɗannan shirye-shiryen biyu kuma ku sa mafi yawan lafiyar lafiyarku.
> Sources:
> Shirin Kula da Lafiya na Yara (CHIP). Yanar gizo na Medicaid.gov. https://www.medicaid.gov/chip/chip-program-information.html.
> Nemo Shirye-shiryen a Jiharka. Yanar gizo InsureKidsNow.gov. https://www.insurekidsnow.gov/state/index.html.
> Ma'aikatan Medicaid da Bayanan Shiga CIP. Yanar gizo na Medicaid.gov. https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/index.html
> Patrick SW, Choi H, Davis MM. Haɓaka cikin wasan tarayya da ke haɗaka da gagarumar samun karɓar ɗaukar hoto ga yara ta hanyar Medicaid da CHIP. Health Aff . 2012 Aug 31 (8): 1796-802. Doi: 10.1377 / hlthaff.2011.0988.
> Racine AD, Long TF, Nemi ME, et al. Shirin Harkokin Kiwon Lafiya na yara (CHIP): ayyuka, kalubale, da shawarwari. Pediatrics. 2014 Mar; 133 (3): e784-93. Doi: 10.1542 / peds.2013-4059.