Ƙasashen baya iya yin amfani da Medicaid ba tare da tallafin tarayya ba
Kafin mu shiga cikin muhawara game da yadda za a sake gyara Medicaid , muna bukatar fahimtar yadda gwamnatin tarayya ke ba da kudi ga wannan shirin. Akwai bambance-bambance a kan kudade bisa ga ko jihar ta shiga cikin ƙwayar Medicaid a karkashin Dokar Kulawa da Kulawa, da Obamacare .
Gwamnatin tarayya ta ba da ƙarin kuɗi ga jihohin da ke ƙaddamar da ƙwayar Medicaid, ta biya kashi 100 na yawan karuwar kudade na Medicaid tun shekarar 2016 da 90 bisa dari na wadannan farashin ta hanyar 2020.
Duk jihohin, ko suna shiga yaduwar maganin Medicaid, sun ci gaba da karɓar kudade na tarayya daga wadannan asali guda uku: Ƙungiyar Ƙwararrun Ƙwararrakin (DSH) Biyan kuɗi, Ƙananan Asusun Kula da Magunguna (FMAP), da Ƙarƙashin Ƙimar Daidaitawa.
Ba da izinin raba asibiti ba
Ba a san maganin maganin Medicaid ne don kasancewa mai karimci ba idan ya zo don biyan bashin kiwon lafiya. Bisa ga bayanan da aka fitar daga binciken binciken lafiyar likita na shekara 2005, an kiyasta kudade na kiwon lafiya kimanin kashi 26 cikin dari na babba tare da inshora mai zaman kansa fiye da wani a kan Medicaid don wannan matakin kulawa.
Asibitoci da ke kula da wasu mutane a kan Medicaid ko kuma mutanen da ba su da izini, a ƙarshe, an sake biya su da yawa fiye da wuraren da ke aiki a yankunan da akwai mutane da yawa da ke rufe asibiti. A 2016 kadai, asibitoci 21 sun rufe ƙofofi don kulawa da kulawa saboda rashin kudaden kuɗi da sauran matsalolin kudi.
Har ma da filin wasa, Ƙididdigar Asibitin Ƙwararrakin (DSH) ba ta biya ba. Ana ba da ƙarin kuɗi na tarayya ga jihohi don raba tsakanin asibitocin da suka cancanci ganin yadda yawancin mutane ba su da yawa. Manufar ita ce ta rage yawan nauyin kudi ga waɗannan wurare don su ci gaba da ba da kulawa ga mutanen da ke da talauci.
Ana amfani da ma'anar daban-daban domin lissafin kudade na tarayya DSH ga kowace jiha. Wadannan takardun suna la'akari da albashin DSH kafin shekara, inflation, da kuma yawan asibitoci na asibiti ga mutane a kan Medicaid ko wadanda basu da hannu. Kudin DSH ba zai iya wuce kashi 12 cikin 100 na kudade na likita na likita na Medicaid na jihar ba a kowace shekara.
Ƙididdigar Taimako na Ƙwararrun Kula da Ƙwararru
Asusun tallafi na likitanci na tarayya (FMAP) ya kasance tushen tushen tushen kudi na Medicaid na tarayya. Manufar ta sauƙi. Domin kowace jihohi $ 1 yana biya wa Medicaid, gwamnatin tarayya ta yi daidai da kashi 100, watau dollar na dollar. Mafi yawan karimci a jihar shi ne a rufe mutane, mafi yawan karimci da gwamnatin tarayya take bukata. Babu wata takarda, kuma kudade na tarayya sun karu ne bisa ga bukatun jihar.
Yayin da kake tunani game da wannan, FMAP na da karimci amma mai yiwuwa ba daidai ba ne ga jihohin da ke da ƙananan samun kudin shiga idan aka kwatanta da jihohin da mafi girma. Musamman, ana iya ƙara yawan nauyin da aka sanya a jihohi tare da ƙananan karuwar talakawa, kuma FMAP na iya ba da kuɗin kuɗi maras nauyi ba tare da bukatun tattalin arzikin jihar ba.
Don magance wannan batu, Dokar Tsaro ta Jama'a ta ƙaddara wata hanyar da za ta lissafta yawan kuɗin FMAP bisa ga yawan kuɗin da ake samu a cikin ƙasa a cikin ƙasa. Yayin da kowace jihohi ta karbi akalla FMAP na kashi 50 cikin dari (Gwamnatin tarayya ta biya kashi 50 na kudaden Medicaid, watau $ 1 ga kowane dala 1 da gwamnati ta shafe), wasu jihohin zasu karbi kashi mafi girma.
Alaska, California, Connecticut, Maryland, Massachusetts , Minnesota, New Hampshire, New Jersey, New York, North Dakota, Virginia, Washington, da kuma Wyoming sune jihohi kadai a 2017 don samun FMAP na kashi 50. Duk sauran jihohi suna karɓar kudaden magani na Medicaid mafi girma daga gwamnatin tarayya.
Koda yake, Mississippi yana da matsakaicin kudin shiga ta kowane fanni tare da FMAP 2017 na kashi 74.63. Wannan na nufin gwamnatin tarayya na biya kashi 74.63 na kudaden Medicaid na jihar, yana bayar da $ 2.94 na kowace $ 1 da jihar ke ciyarwa.
Ƙimar da aka haɓaka
Hanyoyin da aka haɓaka daidai da su kamar FMAP ne amma an ɗauki mataki ɗaya. Suna ƙara yawan farashin da gwamnatin tarayya ta biya don wasu ayyuka. Waɗannan ayyuka sun haɗa da amma ba'a iyakance ga:
- Yara da kuma ciwon jijiyoyin jiki (biya a jihohi na CHIP FMAP *)
- Ayyukan tsara iyali (biya a FMAP na 90 bisa dari)
- Ayyukan kiwon lafiya na gida (biya a FMAP na 90 bisa dari)
- Ayyuka na karewa ga manya (biya a jihar FMAP + 1 kashi)
* CIP shine Shirin Kula da Kiwon Lafiya na Yara
Wadannan ayyuka ana ganin su suna da muhimmanci saboda suna iya taimakawa wajen rage yawan nauyin kula da lafiya a nan gaba. A wannan hanyar, ana ganin ana kashe ƙarin kuɗin kuɗi a matsayin zuba jari mai dacewa.
Asusun kasa don Medicaid
Kada mu manta cewa gwamnatocin jihohi suna bayar da gudunmawa ga Medicaid. Yadda suke yin wannan ya bambanta daga jihar zuwa jiha, amma irin yadda suke taimakawa zai tasiri irin taimakon da suke samu daga gwamnatin tarayya. Gaskiyar ita ce, ba gwamnatocin tarayya ko gwamnatocin jihohi ba zasu iya biyan kuɗin Medicaid ba. Sai kawai tare zasu iya samar da albarkatu don kula da miliyoyin mutane da suke buƙata.
> Sources:
> Ƙarin Kulawa na Kula da Magungunan Medicaid. Shafin yanar gizon Majalisar Dokoki na kasa. http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx. Updated Disamba 1, 2016.
> Clemans-Cope L, Holahan J, Garfield R. Medicaid Girman Tattalin Girma Da aka kwatanta da Sauran Masu Biyan Kuɗi: A Dubi Shaida. Henry Kaiser J. Family Foundation. http://kff.org/report-section/medicaid-spending-growth-compared-to-other-payers-issue-brief/. An buga Afrilu 13, 2016.
> Harkokin asibitin Ellison A. 21 a 2016. Binciken Asibitin Becker. http://www.beckershospitalreview.com/finance/21-hospital-closures-in-2016.html. An wallafa shi a Janairu 6, 2017.
> FY2017 Kashi na Asusun Kula da Harkokin Kiwon Lafiyar Tarayya. Ofishin Mataimakin Sakataren Harkokin Kasuwanci da Bincike, Ma'aikatar Lafiya ta Ma'aikatar Harkokin Kiwon Lafiya ta Amurka. https://aspe.hhs.gov/basic-report/fy2017-federal-medical-assistance-percentages. An buga ranar 13 ga watan Janairu, 2016.
> Mitchell A. Medicaid Ba tare da izini raba asibiti ba. Cibiyar Nazarin Girka. https://fas.org/sgp/crs/misc/R42865.pdf. An buga Yuni 17, 2016.