Ndondomeko ya boma yokankhira inshuwaransi yazaumoyo ya anthu omwe amapeza ndalama zochepa kuposa chisamaliro chamankhwala chachikhalidwe

Jesse Cooper ndi manejala wa pulogalamu ya Medicaid ku California, ndipo sanawope zovuta zazikulu.

Anayenda maola awiri kuchokera ku Bakersfield kupita ku Los Angeles kukamaliza chaka chomaliza ku USC atabereka mapasa.

Zaka zingapo pambuyo pake, ndili ndi zaka 27, chipatala chachikulu cha chigawo chinathandizira kuchepetsa ndalama ndi kuwirikiza kawiri kukula kwa pulogalamu yake kwa odwala omwe alibe inshuwaransi, omwe amapeza ndalama zochepa powagwirizanitsa ndi oyang’anira chisamaliro, omwe amawathandiza kuyenda m’njira zovuta zaumoyo ndikukhala kunja. wa dipatimenti yowopsa.

Tsopano, wazaka 39 wapanga kuyesetsa kwakukulu mdziko muno kukankhira chithandizo cha Medicaid kupitilira makoma anayi achitetezo chachikhalidwe.

CalAIIM, yomwe inayamba kugwira ntchito pa Jan. 1, idzakhudza anthu pafupifupi 15 miliyoni omwe athandizidwa ndi pulogalamu ya Medicaid ya Medi-Cal, California. Idzawonjezera mapindu atsopano a mano, kusintha momwe Medi-Cal amachitira chizolowezi ndi matenda amisala, ndikukulitsa kuchuluka kwa chisamaliro choyendetsedwa m’boma, pakati pa zosintha zina.

Koma gawo labwino kwambiri la CalAIM limayang’ana gulu laling’ono: anthu omwe alibe malo otetezeka, okhazikika okhalamo. Ndi CalAIM, Cooper akubetcha kuti ngati Medi-Cal ingathandize anthu kupeza ndi kukhala m’nyumba, adzakhala athanzi ndikuchepetsa mtengo ku boma pakapita nthawi.

“Ndizoposa kungolipira kukacheza kuchipinda chodzidzimutsa kapena kulipira kukayendera kuchipatala,” adatero Cooper. “Timasamalira ena mwa anthu omwe ali pachiwopsezo komanso opeza ndalama zochepa m’boma lino, ndipo ntchito yathu ndikuchita zambiri.”

Kupanga pulogalamu yoyamba ya Medicaid yamtundu wake

CalAIM idayamba kuchitika mu Epulo 2018, pomwe Cooper adawoloka California kuti amve kuchokera kwa othandizira a Medi-Cal ndi ma inshuwaransi za zomwe akuganiza kuti zikugwira ntchito mu pulogalamuyi ndipo sizinali.

Pafupifupi paliponse, ndimayang’ana m’maboma, zipatala, komanso mapulani osamalira odwala akugwira ntchito yothana ndi mavuto amtundu wa odwala kuti akwaniritse zosowa zawo zaumoyo.

Cooper adakhala miyezi 10 yotsatira akuyang’ana pa kusamutsa zomwe adaphunzira ku CalAIM.

Chimodzi mwa zinthu zovuta kwambiri chinali kupeza momwe boma la federal lingaperekere zinthu zomwe sizinali zachipatala. Dziko lililonse limayendetsa pulogalamu yake ya Medicaid koma limagawana ndalama ndi boma la federal, lomwe lili ndi malamulo okhwima pa zomwe mudzalipira. Mwachitsanzo, ndalama za federal Medicaid sizingapite kukalipira lendi ya wina.

Mapulogalamu onse omwe Cooper adawonera paulendo wake womvetsera adathandizidwa ndi mapulani azaumoyo, zigawo kapena zipatala popanda kubweza kwa Medicaid, kapena anali mbali ya mapulojekiti ang’onoang’ono oyendetsedwa ndi Medicaid.

Cooper akukumbukira akudziganizira yekha kuti: “Pali zinthu zonsezi zomwe zikugwira ntchito ndi anthu omwe kale sitinathe kuwapezera mayankho kapena sitinawalipirire. Kodi ndingapeze bwanji njira yolipira? lipirani china chake, mukachipereka ndalama ndipo chikakhala chokhazikika, chimatha kukula. ”

Kuti apeze chuma chokhazikika, Cooper adatembenukira ku “m’malo mwa mautumiki,” gawo la malamulo a federal Medicaid omwe amalola kuti mapulani osamalira alipire – ndikubwezeredwa – chithandizo chamankhwala chomwe sichiri chachikhalidwe, bola ngati ali ndi kulumikizana ndi achipatala. thanzi la odwala komanso kukhala ndi chidziwitso chowonetsa kuti ndi othandiza.

M’kupita kwa miyezi iwiri kapena itatu, Cooper ndi anzake anachepetsa ndandanda yawo kufika pa 14 “Society imathandizira” Izi zitha kukhala zofunikira za CalAIM. Pafupifupi onse anali okhudzana ndi nyumba, kuyambira kuthandiza munthu kupeza nyumba ndi kulipira lendi ya mwezi woyamba mpaka kusunga munthu m’nyumba mwawo polipira kuchotsa nkhungu pamakoma kapena kukhazikitsa mipiringidzo yolanda bafa.

“Polola munthu kukhala ndi nyumba, angayambe kuganizira za momwe amachitira zinthu zina m’miyoyo yawo chifukwa alibe nkhawa kuti agona kuti kapena adya chiyani lero,” Cooper adatero, mwachidule. filosofi kumbuyo kwa mautumiki atsopano.

Cooper yaphatikiza chithandizo chamagulu ndi chinthu china chatsopano ku CalAIM, Kulimbikitsa kasamalidwe ka chisamaliroyomwe ingapereke odwala ndi woyang’anira chisamaliro kuti awathandize kugwirizanitsa zosowa zawo zonse zachipatala ndi zamagulu.

Cooper adakhala 2020 ndi 2021 kukopa akuluakulu aboma ndi boma kuti asaine CalAIM asanalandire chilolezo chomaliza kuchokera ku federal Centers for Medicare and Medicaid Services patangotha ​​​​masiku ochepa Khrisimasi 2021.

“Ndinabwera kunyumba ndipo mwamuna wanga anatsegula botolo la champagne, ndipo ndithudi ndinalemba CalAIM pa cork ndipo ndikusunga kwa nthawi yaitali,” adatero Cooper.

CalAIM ikugwira ntchito

Dale Stout ndi m’modzi mwa anthu oyamba ku California kugwiritsa ntchito mwayi pa CalAIM.

Stout adadwala sitiroko kumayambiriro kwa chaka chino, ndipo ali m’chipatala, Bank adapita kunyumba kwake.

“Zinagwa ngati toni ya njerwa,” adatero.

Stout ankawopa kuti atha kukhala m’nyumba kapena m’misewu, koma wogwira ntchito zachipatala adamutumiza ku Illumination Foundation, bungwe lopanda phindu lomwe limayang’anira ntchito za nyumba ndi zaumoyo ku Southern California.

Chifukwa cha CalAIM, kampani ya inshuwaransi ya Stout’s Medi-Cal idalipira chifukwa chokhala ku Illumination Foundation. chitonthozo chamankhwala ku Riverside, komwe adatha kupitiliza kuchira. CalAIM adalipiranso wogwira ntchito zamilandu kuti athandize Dale kupeza malo atsopano okhala ndikupempha thandizo la nyumba.

“ngati [Illumination Foundation] Stout anatero. “Ndifa.”

M’malo mwake, Stout waphunzira kuyenda, kukhala wosaledzeretsa, adapanga nthawi zonse zachipatala, ndipo akuyenera kuchitidwa opaleshoni yaubongo kugwa uku.

Pulogalamu yodzifunira yokhala ndi zovuta zambiri

Nkhani ya Stout ndi chizindikiro cha chimodzi mwazovuta zazikulu za CalAIM: kupezeka kwa nyumba.

Pambuyo pa miyezi yokhala ndi thanzi labwino kuti asamukire kumalo ake, Stout adakali ku Illumination Foundation akudikirira kuti voucher ya nyumba ifike, zomwe CalAIM sakanatha kuchita zambiri kuti asinthe.

“Zimakhala zovuta mukakhala ndi zidutswa zazithunzi zomwe zikugwira ntchito bwino, ndiyeno mukukumana ndi malire omwe simupereka ndalama,” atero Cooper, injiniya wa CalAIM.

Stout akupita kukatenga vocha asanachoke ku Illumination Foundation mu Disembala. Koma California ikukumanabe ndi vuto la kusowa pokhala. The Zoyerekeza Zaposachedwa Adayika anthu osowa pokhala aku California pafupifupi 161,000, omwe ndi ochulukirapo kuposa anthu 3,800 omwe CalAIM adathandizira kupeza malo okhala, kapena anthu 5,900 a CalAIM adathandizira kukhala kwawo.

Zodetsa nkhawa zina zimayang’ana pa njira zoyendetsera pulogalamu yomwe akufuna: kodi pulogalamuyi ipeza opereka chithandizo chokwanira kuti apereke chithandizo chatsopanochi? Kodi opereka awa atha kuthana ndi zovuta zoyendetsera ntchito za Medicaid? Kodi madotolo, anamwino, ndi ogwira nawo ntchito adzadziwa za CalAIM Patient Referral Program?

Chodetsa nkhawa chachikulu kwa olimbikitsa ogula a boma ndikuti ngati mapulani osamalira oyendetsedwa – omwe ali ndi udindo wopereka mautumiki atsopanowa, osagwirizana – adzatha kupereka.

“Zolinga zaumoyozi sizikhala ndi mbiri yabwino, ngakhale kupereka chithandizo chofunikira chachipatala – katemera wa ana, kupereka mwayi wopeza chithandizo chamankhwala ndi akatswiri omwe odwala amafunikira,” anatero Anthony Wright, mkulu wa bungwe la Health Access California. .

Mapulani osamalira owongolera safunikira kuti apereke chithandizo chamagulu, koma kuyambira pa Julayi 1, mapulani onse 24 amapereka osachepera awiri.

Kodi CalAIM idzathandiza odwala ndikusunga ndalama?

Paula LantzD., wofufuza pa yunivesite ya Michigan yemwe wakhala zaka zambiri akuphunzira za Medicaid pofuna kupititsa patsogolo thanzi lawo pokwaniritsa zosowa za odwala, akuda nkhawa ndi zonena kuti CalAIM idzapulumutsa ndalama za boma.

Pamene ena maphunziro anasonyeza kuti kuteteza anthu ndi kuwapatsa chithandizo chothandizira kumapulumutsa ndalama m’kupita kwa nthaŵi, Lantz akutero Ndemanga ya mabuku ya 2019 Iye adalembanso kuti kulumikiza odwala ovuta ndi ntchito zachitukuko sikumabweretsa zotsatira zabwino kapena kutsitsa mtengo poyerekeza ndi odwala omwe adalandira chithandizo chamankhwala.

Zochita zamtunduwu nthawi zambiri zimagulitsidwa mochulukira kuti zivomerezedwe ndi ndale ndi chuma ponena kuti sizingawononge ndalama zilizonse.” “Chodetsa nkhawa changa chachikulu ndichakuti pangakhale zotsatira zabwino za zomwe akuchita zomwe sizikuwoneka bwino, komanso ndiye Zimangopangitsa kuti anthu asafunenso kuyikamo ndalama.”

Cooper ali ndi chidaliro kuti CalAIM idzapulumutsa ndalama chifukwa ambiri mwa mautumikiwa achita zomwezo monga oyendetsa ndege apakhomo. Dipatimenti yake ikuyerekeza kuti ngati kugwiritsa ntchito zipinda zadzidzidzi, kugona m’chipatala, ndi chisamaliro chanthawi yayitali kutsika ndi 3.3 peresenti pofika 2026, zomwe zidzathetsere ndalama zothandizira anthu ammudzi.

Koma ichi sichotsatira chofunikira kwambiri m’maganizo mwake.

“Tiyenera kusamala ndi ndalama za okhometsa msonkho, koma ngati zotsatira za thanzi la anthu zikuyenda bwino ndipo amapeza mwayi wopeza ntchito zomwe akufunikira, ndikuganiza kuti ndizopambana. Izi ndi zomwe tikuyesera kuchita, “adatero Cooper.

Cooper akudziwa kuti kugwiritsa ntchito CalAIM kudzakhala njira yayitali komanso yosokoneza, koma akudzipereka ku lingaliro lakuti Medicaid ikhoza ndipo iyenera kuchita zambiri kwa mamembala ake omwe ali pachiopsezo kwambiri.

“Ndikuganiza kuti zikungodutsa malire a zomwe tiyenera kuchita, zomwe dera lathu liyenera kuchita,” adatero. “Chifukwa chake ndi mwayi wabwino kwambiri, ndipo ndikukhulupirira titha kukumana pakadali pano.”

Nkhaniyi ikuchokera ku Tradeoffs Health Policy Podcast, mnzake wa Side Effects Public Media. Dan Gorenstein ndi Executive Editor wa Tradeoffs, ndipo Leslie Walker ndi mtolankhani/wopanga mndandanda, womwe unasindikiza nkhaniyi pa Seputembara 22. Kupereka ndalama zothandizira zaumoyo kumathandizidwa ndi Arnold Ventures ndi West Health.

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