Inzu y'abageze mu zabukuru vyihutirwa Medicaid Gutegura ingorane no kurinda umutungo w'uwo bubabakanye¶

Iyo umuntu akuze arwaye indwara y’umutima ikomeye, akavunika igihimba c’irondoka, canke indwara ya Alzheimer igatera bukwi na bukwi, maze akava mu bitaro akaja mu bitaro vy’abaforomo b’abahinga (SNF), imiryango ica ihita igira ingorane z’amahera. Ubwishingizi bw’ubuzima busanzwe na Leta Zunze Ubumwe za Amerika Medicare Igice ca A ntivyishura ubuvuzi bw’igihe kirekire bwo mu nzu y’abageze mu zabukuru iyo gusubirana kw’igihe gito kw’abahinga guheze (mu bisanzwe inyuma y’imisi 20 gushika ku 100). Mu kanya nk’ako gukubita, ibiro vy’ubudandaji vy’inzu y’abageze mu zabukuru birashikirizwa umuryango amafaranga y’abantu ku giti cabo y’amadolari y’Amerika 9.000 gushika ku 15.000 ku kwezi (canke amapawundi 1.200 gushika ku 1.800 ku ndwi mu Bwongereza), ivyo bikaba bituma ababiranye n’abana bakuze bagira amasezerano abiri ateye ubwoba. n’uwujejwe amafaranga y’umuvyeyi, canke gutanga amahera umuvyeyi yazigamye ku ncuti biwe mu kurenga ku Igihe co Gusubira inyuma c’amezi 60 (imyaka 5) ca Medicaid.

Ntubwirizwa gusenyuka, kugurisha inzu y’umuryango, canke gukenera uwo mwubakanye afise amagara meza muhira kugira ngo umuntu ukunda ashobore guhabwa Long-Term Care Institutional Medicaid, mbere n’igihe umurwayi asanzwe yicaye mu gitanda c’inzu y’abageze mu zabukuru uno musi ataco yiteguriye. Itegeko rya Federal Medicaid (42 U.S.C. § 1396r-5) rishiraho Ubukene bw'Umugabo bubabakanye bukomeye bwemerera "Umugabo Bubabakanye" yubatse aba muhira kuguma afise uburaro bwose bw'umuryango, imodoka imwe, ibintu vy'umuntu ku giti ciwe, gushika kuri **154,400). Spouse Resource Allowance, ihindurwa buri mwaka), n’amahera ashika ku amadolari 3.853,50 ku kwezi y’amahera yose hamwe, mu gihe yemerera abasaba amahera atarongoye canke bubatse guhindura amahera arenga mu mitungo isonerwa n’amategeko aho nyene. Iyi nkuru itanga intambwe zihutirwa zo guhagarika umukazo w’amahera utemewe n’amategeko wo mu nzu y’abageze mu zabukuru, kwirinda ibihano vyo kwimurira inyuma, no gukora igikorwa c’ivyihutirwa co gukoresha amahera ya Medicaid.

Ivyo ubikore ubu¶

1. Ntukigere ushira umukono ku masezerano yo kwakirwa mu nzu y'abageze mu zabukuru mw'izina ryawe bwite canke nk'"Umucungezi w'amahera." Nimba umuvyeyi ariko arashikirwa n'ingorane zikomeye z'ubuvuzi mu gihe c'amatati y'ubuvuzi, hamagara inomero y'ivyihutirwa yo mu karere kawe (911 muri Leta Zunze Ubumwe za Amerika no muri Kanada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza) canke usuzume ivyacu . inomero z'ivyihutirwa ububiko. Mu itegeko ry’ubutegetsi bwa Leta Ivugurura ry’Ingoro z’Abageze mu zabukuru (42 U.S.C. § 1396r©(5)(A)(ii)), ikigo kirabujijwe cane gusaba umwana akuze canke uwundi muntu we ubwiwe kwishingira ko azokwishurwa nk’itegeko ryo kwemererwa; n'ushireko umukono nk'"Umugenzuzi afise ububasha bwo gutanga uburenganzira bwa [Izina ry'Umuvyeyi], ata n'umwe afise uruhara rw'amahera."
2. HAGARARA ubwo nyene imbere yo gutanga ingabirano, kwimurira, canke kwongerako izina ry’umwana kuri konti iyo ari yo yose yo muri banki, ku nyandiko y’inzu, canke ku mpapuro z’imodoka. Gutanga amahera canke kugurisha umutungo kugiciro kiri munsi y’agaciro k’isoko mu kiringo c’amezi 60 (imyaka 5) imbere yo gusaba ubufasha bwo mu nzu y’abageze mu zabukuru (amezi 30 yo kwimurira abavyeyi muri California) Igihe c’Igihano**, gusiga umukuze ata mahera n’ ubufasha bwa Medicaid amezi canke imyaka.
3. Ntukigere ugurisha inzu y'umuryango canke ngo ushireho amahera y'ikiruhuko c'izabukuru kugira ngo wishyure inzu y'abageze mu zabukuru imbere yo kugisha inama Umuvugizi w'Itegeko ry'Umusaza canke umujanama w'Ubwato. Ku bubakanye (canke umusaza umwe gusa atanga inyandiko yashizweko umukono "Intent to Return Home" gushika ku gipimo c'uburinganire bwa leta c'amadolari 713,710,000). uburaro bwa mbere ni umutungo USONEWE kugira ngo umuntu ashobore guhabwa Medicaid, mu gihe kugurisha inzu bihindura inzu isonewe mu mafaranga aharurwa inzu y’abageze mu zabukuru izofata.
4. Gusaba ibara ry'"Isuzuma ry'Itunga / Itariki y'Igishushanyo" iyo uwuba mu nzu y'abageze mu zabukuru yubatse. Mu mategeko ya Leta Zunze Ubumwe za Amerika Ubukene bw'uwo bubabakanye, uwo bubabakanye afise amagara meza aba mu rugo (Uwo bubabakanye wo mu kibano) arafise uburenganzira bwo kuguma mu nzu y'abageze mu zabukuru irindwa n'uwubaye mu nzu y'abageze mu zabukuru. Ikihembo gitoyi c’ukwezi (MMMNA) rero ntibasiga bacitse intege.
5. Guhindura "Itunga Rishobora Guharurwa" mu "Itunga Risonerwa" mu buryo butegekanijwe n'amategeko nimba ukeneye gukoresha amahera vuba imbere y'uko ukwezi kw'ikirangamisi guhera. Aho gutanga amahera arenga uzigamye ku nzu y'abageze mu zabukuru canke kuyatanga mu buryo butemewe n'amategeko, abasaba barashobora gukoresha amahera ashobora guharurwa mu buryo butegekanijwe n'amategeko ku **cha-for-ga-gemp or gusanura inzu y’umuryango isonewe, kugura Ikigega c’amaziko n’uguhamba kidashobora gusubirwamwo, kugura ubuvuzi bw’amenyo bukenewe, amataratara, canke intebe y’ibimuga, canke gushitsa amafaranga y’umwaka y’uwo bubabakanye yubahiriza amategeko ya Medicaid.
6. Shira ubusabe bwa "Medicaid Pending" maze wemeze uburenganzira bwawe bwo kwirukanwa mu gihe Leta iriko irakora dosiye. Mu mategeko ya Leta y'Uburundi y'ugusohoka mu nzu y'abageze mu zabukuru (raba uburongozi bwacu ku guhohoterwa mu rugo rw'abageze mu zabukuru, gusuzugurwa, no kwiregura mu kwirukanwa), ikigo c’ubuvuzi cemejwe na Medicaid ntigishobora kwirukana umuturage kubera ataco yishuye mu gihe ubusabe bwatanzwe bwa Medicaid bw’igihe kirekire buriko burategerezwa n’ikigo ca leta.

flowchart TD
    A["Umukuze asaba kwitaho mu nzu y'abageze mu zabukuru (Iherezo rya Medicare Rehab)"] --> B{"Mbega uwo muvyeyi aba mu nzu y’abageze mu zabukuru yubatse canke ntarongoye/n’umupfakazi?"}
    B -->|"Uwurongoye (Umugabo umwe aba muhira)"| C["Gusaba amategeko agenga ubukene bw’uwo bubabakanye (42 USC 1396r-5)"]
    B -->|"Uwutarongoye, Uwahukanye canke Uwupfakaye"| D["Igenzura rishobora guharurwa n'itunga risonerwa ku madolari 2.000 y'umuntu ku giti ciwe (Irengeye muri CA/NY)"]
    C --> E["Inzu, Imodoka 1, n’Ibishika ku madolari 154.140 CSRA Irinzwe ku Mubano Uwurongowe + Ihinduka ry’Ivyinjira (MMMNA)"]
    D --> F["Gukingira Icumbi ry'Ibanze biciye ku 'Iciyumviro co Gusubira Muhira' canke Gusonerwa Umwana Yitaho"]
    E --> G{"Mbega Ivy’Itunga Bisigaye Bishobora Guharurwa Biracari Hejuru y’Ikigereranyo ca Leta?"}
    F --> G
    G -->|"Ego: Amafaranga arengeje urugero"| H["Gushitsa Ingorane z’Itegeko Gukoresha Amahera-Hasi IMBERE y’Iherezo ry’Ukwezi (NTUZOKWIGEZE Utanga Itunga mu Myaka 5)"]
    G -->|"Oya: Mu rugero rw'umutungo"| I["Suzuma Inyungu y'Ukwezi Ugereranije n'Igihugu 'Igipimo c'Inyungu' (Koresha Inyungu Ibereye / Miller Trust nimba Bikenewe)"]
    H --> I
    I --> J["Dosiye y'Ukwitaho Igihe Kirekire Medicaid (Itera 'Medicaid Itegereje' Uburinzi bwo Kwirukanwa)"]

Kubera iki Medicare ihagarika kwishura inyuma y’imisi 20 gushika ku 100 (Ubuhinga n’Ubucungezi)¶

Ico kibazo c’amahera gisanzwe mu gihe umuntu asaza kiba hafi y’umusi wa 20 gushika ku musi wa 35** w’ugumara inyuma y’ibitaro mu kigo c’abaforomo b’abahinga (SNF). Imiryango yumva mu bitaro ko "Medicare itanga imisi 100 yo gusubira mu nzu y'abageze mu zabukuru," gusa ikaronka Itangazo ry'uko Medicare idatanga (Ifomu CMS-10123) haciye indwi zitatu ivuga ko Medicare izohera mu masaha 48 kandi ko umuryango utegerezwa kwishura amadolari 400 gushika ku 500 ku musi ku musi.

Gutahura umurongo w’amategeko uri hagati ya Medicare Igice ca A na Medicare y’Igihe Kirekire ni umushinge w’ugutegura ingorane:

• Igice ca A c’ubuvuzi (Igice gito c’ugusubirana kw’abahinga GUSA): Inyuma y’ugumara mu bitaro amasaha 3 y’ijoro, ubuvuzi bwa gakondo igice ca A gitanga 100 kw’ijana vy’imisi 1 gushika ku misi 20, kandi busaba ubwishingizi bw’umusi ku musi bw’imisi 204 gushika ku musi 204 100** (akenshi bifatwa n'itegeko ry'inyongera rya Medigap), Igihe cose umurwayi asaba kandi akagira uruhara mu "Kwitwararika kw'ubuhinga" kwa misi yose (nk'Ubuvuzi bw'Umubiri bwa misi yose, Ubuvuzi bw'Akazi, Ubuvuzi bw'Ijambo, canke Ubuvuzi bw'Ibikomere bukomeye). Umusi nyawo umurwayi ashobora gukora neza canke basaba gusa "Custodial Care" (ugufashwa mu kwoga, kwambara, kwiyuhagira, kurya, no kugenzura ubumuga bwo mu mutwe), Medicare Part A iriha $0, naho umurwayi yoba yakoresheje gusa imisi 18 mu misi 100 yamaze. (Niba wemera ko rehab iriko iracika imbere y’igihe mu gihe umukuru ashobora gutera imbere, ushireho ubujurire bwa QIO ukoresheje ubuhinga bwacu Ibitaro bitagira umutekano canke ubuyobozi bwo gusohoka mu bitaro.)
• Ikigo c’ubuvuzi bw’igihe kirekire (Uburezi buhoraho + ubuvuzi bw’ubuhinga): Igihe umukuze asavye kwitaho ubudasiba amasaha 24 mu nzu y’abageze mu zabukuru kandi atagira ubwishingizi bw’ubuvuzi bw’igihe kirekire bwite, Medicaid ni porogarama ya mbere ya Leta ikoreshwa muri Leta Zunze Ubumwe za Amerika. itegeko ry’inzu y’abageze mu zabukuru ubuziraherezo ubuzima bwose bw’uwubamwo, igihe amategeko agenga ivy’amahera n’ivy’ubuvuzi (“Urugero rw’Ukwitwararika Ikigo c’Abageze mu zabukuru”) amaze gushitswako.

Itunga rishobora guharurwa n'iryo gusonerwa: ivyo Medicaid iguha uburenganzira bwo kubika¶

Kugira ngo umuntu ashobore guhabwa ubufasha bw'ubuvuzi bw'igihe kirekire mu bihugu vyinshi vya U.S., "Itunga ry'abageze mu zabukuru" (itunga ridasonerwa) ry'uwusaba inzu y'abageze mu zabukuru ritegerezwa kuba riri munsi y'amadolari 2.000** ku musi wa nyuma w'ukwezi (iciyumviro: **California yashizeho umupaka nk'uko,2 New York yadugije umupaka w’itunga ry’umuntu ku giti ciwe gushika ku madolari arenga 31.175).

Ariko rero, Medicaid nti iharura ivyo ufise vyose ku rugero rw’amadolari 2.000. Amategeko ya Medicaid ya Leta Zunze Ubumwe za Amerika n’aya Leta agabanya umutungo wose mu Itunga Risonerwa (Idashobora Guharurwa) ushobora kubika mu mwidegemvyo, n’Itunga Rishobora Guharurwa ritegerezwa kurindwa canke gukoreshwa.

Uburinzi bw’ubukene bw’ababiranye (igihe umwe mu babiranye aguma i muhira)¶

Imbere y’uko Kongre ishiraho Itegeko ry’Ubuvuzi ryo mu 1988 (42 U.S.C. § 1396r-5), igihe umugabo yinjira mu nzu y’abageze mu zabukuru, abo bubakanye bategerezwa gukoresha hafi amahera yose bari bazigamye mu buzima bwabo gushika ku madolari 2.000 y’ubuvuzi, imbere y’uko Medicaid itanga amadolari 2.000. Ubu, Itegeko ry’ubukene bw’ababiranye ry’igihugu rigabanya ababiranye mu Umubiranye afise inzego (mu nzu y’abageze mu zabukuru) n’Umubiranye wo mu kibano (aba muhira canke mu buzima bwigenga) kandi rikingirira itunga n’amahera yinjizwa mu kwezi mu rugo ku...

1. Gukingira amafaranga y’ubugeni: Infashanyo y’umuryango w’ababiranye (CSRA)¶

Mu itegeko rya Leta Zunze Ubumwe za Amerika, Medicaid ihuriza hamwe itunga ryose rishobora guharurwa ry’umwe mu babiranye (ataco yitaye ku izina ryiwe riri kuri konti ya banki canke nimba basinye amasezerano y’ubugeni) kandi irekura Uwo bubabakanye wo mu muryango kuguma afise umugabane urindwa witwa Ikigega c’uwo bubabakanye wo mu muryango (CS)

• CSRA irengeye (Itegeko rya Leta 2024/2025): Gushika kuri amadolari 154.140 (ahindurwa aja hejuru buri kwezi kwa mbere kubera ugutera imbere kw’ibiciro) mu kuzigama kw’amahera, PLUS inzu y’umuryango isonewe, imodoka imwe, n’amaziko yishuwe imbere y’igihe, mu gihe S0 amadolari.
• "100% y'Ibihugu vya CSRA" n'"50% vy'Ibihugu vy'Igishushanyo":
  • Mu bihugu 100% (nka Florida, Texas, New York, Pennsylvania, Georgia, na Colorado), Uwo Bubabakanye wo mu Muryango aca agumana 100 kw’ijana vy’itunga ry’ababiranye rishobora guharurwa gushika ku giciro c’amadolari 154.140.
  • Mu 50% vy'ibihugu vy'amafoto (nka Ohio, New Jersey, Carolina yo mu Buraruko, Virginia, na Indiana), uwo bubabakanye wo mu muryango agumya igice kimwe (50%) c'itunga ryose ry'ababiranye nk'uko bipimwa ku "Itariki y'amafoto" (umusi wa mbere w'umuvyeyi w'umuvyeyi aguma mu bitaro/0y Igiciro gitoyi ca CSRA c’amadolari 30.828 n’igitigiri c’amadolari 154.140**.

2. Gukingira Inyungu y’Ukwezi: Inyungu ntoyi y’Ukwezi y’Ukwezi (MMMNA)¶

Itegeko rya Leta Zunze Ubumwe za Amerika rikoresha amategeko abiri atandukanye cane ku Ivyinjira mu kwezi (amasheki y’ubwishingizi, amapensiyo, amafaranga y’umwaka) ku bubakanye:

1. Itegeko ry'"Izina ku giciro" ry'Ivyinjira vy'Umukenyezi wo mu Muryango: Icegeranyo cose c'Ubwishingizi bw'Igihugu canke c'Isheki ya pansiyo co mu kwezi cose gishobora kwishurwa mu izina ry'Uwo bubabakanye wo mu Muryango ni 100 kw'ijana ry'Uwo bubabakanye wo mu Muryango. Naho amahera y’uwo bubabakanye afise amagara meza yoba ari manini gute canke amahera y’ubwishingizi bw’ubuzima, Medicaid ntishobora gukora ku gice na kimwe c’amahera y’uwo bubabakanye yo mu Muryango ubwiwe aronka ku kwezi kugira ngo yishure amafaranga y’ukwitaho uwo bubabakanye afise amagara meza mu nzu y’abageze mu zabukuru.
2. Guhindura inyungu iva ku wo bubabakanye mu nzu y'abageze mu zabukuru KU mugenzi w'abageze mu zabukuru (The MMMNA): Mu bisanzwe, uwuba mu nzu y'abageze mu zabukuru ari kuri Medicaid ategerezwa kwishura igice kinini c'amahera yiwe bwite y'ukwezi ku kwezi n'amafaranga y'ubwishingizi bw'abageze mu zabukuru ku mafaranga y'inzu y'abageze mu zabukuru ("Ikibazo c'umurwayi / Umugabane w'Igiciro") y’amadolari 50 gushika ku 130 ku kwezi. ARIKO, iyo Uwo bubabakanye wo mu kibano afise amagara meza mu rugo afise amahera makeyi yinjiza ku kwezi, ari munsi y’amahera Leta atanga ku kwezi (MMMNA)**, ashobora kuva ku madolari 2.555 gushika ku madolari 3.853,50 ku kwezi. kwimurira igice (canke vyose) vy’amahera yabo y’ukwezi ku kwezi y’Ubwishingizi bw’Igihugu n’ay’amapensiyo ataco baciye ku Mukenyezi w’Umuryango buri kwezi kugira ngo uwo bubabakanye muhira ashike ku rugero rw’amahera yo kubaho ya MMMNA.

Igihe co gusubira inyuma c’amezi 60 (imyaka 5) n’ingene wokwirinda ibihano vyo kwimurirwa¶

Iyo umuryango ubonye ko umuvyeyi yireranye abana afise amadolari 80.000 kuri konti yo kuzigama kandi akeneye kuba ari munsi y'amadolari 2.000 kugira ngo abone ubufasha bwa Medicaid, umutima wabo wa mbere ni uwu: *"Reka twandike sheki y'amadolari 78.000 ku bana uno musi, canke tugurishe inzu ya mama ku madolari1 ku madolari kuri app1 ku mwana wiwe kugira ngo abone ubufasha bwa Medicaid."

Uko Umugabane w’Igihano co Kwimurira Medicaid akora (n’igituma ari umutego)¶

Iyo Medicaid ibonye ko mama wawe yahaye abana biwe ingabirano y’amadolari 70.000** ubu hakaba haciye imyaka itatu, Medicaid ntisaba abana ayo mahera mu buryo bw’ikinyabupfura; ahubwo, Medicaid ibara Igihe c’Igihano co Kudakwiriye mu kugabanya amahera yatanzwe n’ukwezi kwa Leta Umugabanyi w’Igihano (igiciro c’ukwezi c’inzu y’abageze mu zabukuru muri Leta yawe, nk’akarorero, amadolari 10.000):

Ikibi kuruta, hakurikijwe Itegeko ryo Kugabanya Amadeni, **iyo saha y’igihano c’amezi 7 NTITANGURA gutera gushika umusi mama wawe (1) aba mu nzu y’abageze mu zabukuru, (2) ubundi yavunitse (munsi y’amadolari 2.000 aheze), KANDI (3) atanga ubusabe bwa Medicaid imyaka itatu,70. uwo muvyeyi ubu ari mu nzu y’abageze mu zabukuru ata mahera afise kandi amezi 7 ataco yishuye, amadolari 10.000 ku kwezi.

(Imiti y'ingorane iyo ingabirano yari yaramaze gukorwa: Iyo umwana akuze agifise amahera yahawe, gusubiza 100 kw'ijana vy'amahera yatanzwe muri konti ya banki y'umuvyeyi "bikiza" igihano co kwimurira burundu kugira ngo bishobore gukoreshwa hasi mu buryo butegekanijwe n'amategeko ku bintu vy'impano zisonerwa, canke an "Ingabirano n'Ikigereranyo c'Umwaka / Ikete ry'Isezerano" ry'ubuvuzi.)

Ivyagezwe bine bidasanzwe aho kwimurira inzu canke amahera bitera igihano ZERO¶

Itegeko rya Leta Zunze Ubumwe za Amerika (42 U.S.C. § 1396p©(2)) ryemerera uwusaba inzu y’abageze mu zabukuru kwimurira aho aba cane canke itunga ryiwe mu mice ine yihariye y’abagize umuryango mbere n’umusi imbere y’uko asaba ubufasha bwa Medicaid ata imyaka 5 yo gusubira inyuma

1. Kwimurira uwo bubabakanye: Kwimurira umutungo uwo ari wo wose canke inyandiko y’inzu hagati y’ababiranye ata n’aho igarukira, birasonerwa igihano 100 kw’ijana.
2. Kwimurira umwana w’impumyi canke w’ubumuga buhoraho (w’imyaka iyo ari yo yose): Umuvyeyi arashobora kwimurira umutungo canke inzu ataco akora ku mwana ahuye n’insobanuro y’Ubwiteganyirize bw’Igihugu y’ubumuga canke ubumuga buhoraho (canke mu **Ikigega c’Ubumuga bw’Ikigo c’Ikigo c’Ikigo c’Ikimuga c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikimuga c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikigo c’Ikimuga.
3. "Ugusonerwa kw'Umwana Yitaho" (Ukwimurira Inzu y'Umuryango): Umuvyeyi arashobora gutanga inyandiko y'inzu yiwe y'umuryango 100 kw'ijana ku buntu kandi igaragara (asonewe ku bijanye n'imyaka 5 yo gusubira inyuma n'ugusubira inyuma kw'Itunga rya Medicaid ryo muri kazoza) ku muhungu canke umukobwa akuze:
   • Yabaye mu nzu y’umuvyeyi ubudasiba nibura imyaka ibiri (2) yuzuye ubwo nyene imbere y’uko umuvyeyi yinjira mu nzu y’abageze mu zabukuru, KANDI
   • Yatanze ubuvuzi bwa misi yose (bugenzuwe n’ikete ry’umuganga be n’ibitabu vy’ubuvuzi) vyatumye umuvyeyi adakenera kwakirwa mu kigo c’abageze mu zabukuru muri iyo myaka ibiri.
4. Ugusonerwa kw'"Umuvukanyi afise inyungu y'uburinganire": Kwimurira inzu umuvukanyi canke umuvukanyikazi asanzwe afise inyungu y'uburinganire muri iyo nzu kandi akayibamwo nibura umwaka umwe (1) ubwo nyene imbere y'uko uwo mukuru yinjira mu nzu y'abageze mu zabukuru.

Urutonde rw'amahera yo gukoresha mu gihe c'ingorane z'amategeko: ingene wogabanya amahera yo guharurwa mu misi 30¶

Nimba umuvyeyi wawe canke uwo mwubakanye ari mu nzu y’abageze mu zabukuru uno musi afise amadolari 20.000 gushika ku 150.000 yo guzigama muri banki ashobora guharurwa hejuru y’urugero rw’itunga rya Medicaid, ntubwirizwa gutanga ayo mahera yose mu nzu y’abageze mu zabukuru. Ukwemererwa kwa Medicaid bimenyekana ku gicapo c’amahera ari muri banki ku umusi wa nyuma w’ikirangamisi w’ukwezi (canke itariki yo gusaba). Ushobora gukoresha amahera arenga urugero gushika ku rugero rw’amadolari 2.000 imbere y’isaha zibiri z’ijoro ku musi wa nyuma w’ukwezi mu kugura ibintu n’ibikorwa ku gaciro k’isoko kabereye ku nyungu y’uwusaba canke uwo bubabakanye:

• Kwishura imyenda n’ingwati ku nzu isonewe: Kwishura canke kwishura ingwati, umurongo w’inguzanyo y’uburinganire bw’inzu (HELOC), umusoro w’itunga usigaye, canke umwenda w’ikarita y’inguzanyo y’uwusaba canke uwo bubabakanye.
• Gukora ibikorwa vyo gusanura no guhindura uburyo bwo gushika ku nzu y'intango isonerwa: Gusubirira igisenge gishaje, gushiramwo ifuru nshasha y'umuyagankuba, gusanura ubwogero bufise igikarabiro gishobora kwinjiramwo, gushiramwo inzira y'abamugaye, gusubirira amadirisho, canke kugura ibikoresho bishasha vyo mu gikoni vyo gukoresha mu nzu y'abanyagihugu.
• Gura umugambi w’amaziko n’uguhamba udashobora gusubirwamwo: Sura inzu y’amaziko ifise uruhusha maze uhindure amadolari 10.000 gushika ku 15.000 ku mwubakanye mu Ikigega c’amaziko kidasubirwamwo cemewe na Leta, itongo ry’amaziko, isandugu, n’ibuye ry’umutwe.
• Guhindura canke gusubirira imodoka y’umuryango isonewe: Gucuruza imodoka ya kera (canke imodoka zibiri za kera) no kugura imodoka imwe yizigirwa nshasha canke y’igihe ca kera (canke imodoka ishobora gukoreshwa n’abamugaye) ifise izina ry’uwusaba canke uwo bubabakanye mu kibano.
• Gura ibintu bitapfutse vy’ubuvuzi, ivy’amenyo, ivy’ugutahura, n’ivy’impumurizo ku bakuze: Gugura amenyo y’ikinyoma canke y’ivy’amenyo, amataratara y’agaciro kanini, ibikoresho vyo kwumva vy’ubuhinga bwa none, intebe y’ibimuga ikoreshwa n’imoteri canke ishobora gutembagazwa mu kirere, intebe y’ibimuga y’imbere y’umubiri, intebe y’imbere y’inzu y’ubuvuzi, imeza y’ubuvuzi, n’izina ryabo ryanditsweko.
• Gushitsa Itegeko ry’Ikigega c’Umwaka (SPIA) (biciye ku Muvugizi w’Itegeko ry’Umusaza): Mu 42 U.S.C. § 1396p©(1)(F)-(G), mu bihugu vyinshi umugabo canke umugore yubatse (canke uwusaba umwe gusa akoresheje ubuhinga bw’igice c’umukate) arashobora guhindura amajana y’ibihumbi vy’amadolari y’amahera arenga ashobora guharurwa mu mahera akinzwe Ashobora guharurwa ukwezi kwose A umugezi w’amahera y’uwo bubabakanye afise amagara meza, igihe cose amahera y’umwaka adashobora gusubirwamwo, adashobora guhabwa uwundi, afise ubushobozi bwo gutanga amafaranga, yishura mu bice bingana buri kwezi, kandi akavuga izina ry’ikigo ca leta ca Medicaid nk’umuntu asigaye azoronka inyungu gushika ku nyungu zihembwa.

Gutorera umuti ingorane y'"Igipfukisho c'inyungu" (Ivyizigiro vy'inyungu zikwiriye / Ivyizigiro vya Miller)¶

Nk’igice c’intara za U.S. (harimwo Florida, Texas, Ohio, New Jersey, Arizona, Colorado, Indiana, na Georgia) zishirwa mu rutonde rw’intara zifise inyungu nyinshi. igipimo, gihindurwa buri mwaka) mbere n’idolari 1, naho inzu y’abageze mu zabukuru igura amadolari 10.000 ku kwezi, mudasobwa ya leta izoca ihakana uburenganzira bwo guhabwa Medicaid kiretse ufunguye konti ya banki yoroshe yitwa Qualified Income Trust (QIT) / Miller Trust.

flowchart TD
    A["Suzuma Amafaranga yose Uwusaba Inzu y'Abageze mu zabukuru Yinjiza mu Kwezi (Ubwishingizi bw'Igihugu + Pensiyo)"] --> B{"Woba uba mu 'Leta y'Igihugu c'Ivyinjira' Kandi Ivyinjira vyose birenze $2.829/Ukwezi?"}
    B -->|"Oya: Munsi y’Igipfukisho canke ‘Igihugu gikeneye Amahera y’Ubuvuzi’."| C["Nta Miller Trust ikenewe: Inyungu ikoreshwa ataco ihinduye ku mugabane w’igiciro c’umurwayi / uwo bubabakanye MMMNA"]
    B -->|"Ego: Amadolari arenga 2.829/Ukwezi mu gihugu gifise inyungu nyinshi"| D["Gushitsa Inyandiko y'Ikigega c'Ivyiza (QIT / Miller Trust)"]
    D --> E["Gufungura konti yihariye yo gusuzuma idafise inyungu yitwa mw'izina rya QIT"]
    E --> F["Ivyo uwusaba yinjiza mu kwezi birenze igipimo co gushiramwo amahera kuri konti ya QIT buri kwezi"]
    F --> G["Kwishura umugabane w'Inzu y'Abageze mu zabukuru w'Igiciro n'Uwo Mwubakanye MMMNA Kuva kuri Konti ya QIT Buri kwezi"]

• Uko ikigega ca Miller gikora: Cemerewe n’itegeko rya Leta (42 U.S.C. § 1396p(d)(4)(B)), Ikigega c’inyungu zibereye (QIT) ni inyandiko yoroshe y’impapuro 4 yashizweko umukono n’umukuru canke Umukozi wabo afise ububasha bwo gutanga umukono. Ujana iyo nyandiko ya QIT yashizweko umukono muri banki iyo ari yo yose, ugafungura konti yihariye y’ugusuzuma yitwa "The [Izina ry’Umuvyeyi] Qualified Income Trust," hanyuma ugashiramwo amahera y’ukwezi y’ukwezi canke y’ubwishingizi bw’ubuzima muri iyo konti ya QIT buri kwezi imbere y’uko uriha Umugabane w’Igiciro c’inzu y’abageze mu zabukuru. Idolari ryose rishizwe mu kigega ca Miller Trust rikurwa mu gipimo c’inyungu c’amadolari 2.829, rigaca rifungura uburenganzira bwo guhabwa ubufasha bwo mu nzu y’abageze mu zabukuru.

Gukingira Inzu y'Umuryango Inyuma y'Urupfu "Ivy'Itunga rya Medicaid" (MERP)¶

Naho uburaro bw’umuryango bwa mbere busonerwa igihe umukuze akiri muzima, itegeko rya Leta Zunze Ubumwe za Amerika (42 U.S.C. § 1396p(b)) risaba ko Leta yose ikoresha Porogarama yo Gusubiza Ivy’Ubufasha bwa Medicaid (MERP) itanga ikirego ku muntu yapfuye amaze guhabwa ubufasha bwa Medicaid amafaranga y’inzu y’abageze mu zabukuru yishurwa mw’izina ryabo.

Rinda inzu y’umuryango wawe ku bijanye n’ugusubirana ivy’ubutunzi inyuma y’urupfu ukoresheje izi ngabo zitegekanijwe n’amategeko:

1. Itegeko ribuza gusubirana ivy’umutungo: Itegeko rya Leta Zunze Ubumwe za Amerika ribuza cane gusubiramwo ivy’umutungo wa Medicaid mu gihe umwe muri bo mu ncuti zikurikira ari muzima:
   • Uwo bubabakanye arokotse (aho baba hose);
   • Umwana atarashika ku myaka 21; canke
   • Umwana w'impumyi canke w'ikimuga ubudasiba w'imyaka iyo ari yo yose.
2. Koresha "Ikete ry'Inyoni y'Umugore" (Ikete ry'Ubuzima ry'Ubuzima) canke "Ikete ry'Ukwimurira ku Rupfu (TOD)" mu bihugu bigabanya ugusubirana kw'Itunga: Mu bihugu vyinshi (nka Florida, Texas, Michigan, n'izindi), Ikete ry'Itunga rya Medicaid rishobora gusa gusaba itunga **teurt **teurt. Kwandika Ikete ry’Ubuzima ryongerekanye (Ikete ry’Inyoni ry’Umugore) mu gihe umukuru afise ubushobozi bwo gukora (canke biciye ku Bushobozi bw’Umuvugizi butanga mu buryo butomoye ububasha bwo gutanga/kwizigira) bigumya 100 kw’ijana vy’ubuzima bwose n’ubugenzuzi ku muntu mukuru (bituma **zero automatically 5-year transfer du **side pen-back life probate ku rupfu, bikayikingira gusubirana ivy’umutungo.
3. Ibihuye n’ivyo mpuzamakungu (Ubutegetsi bw’Intara y’Ubwongereza bwo Kwitwararika, Amasezerano y’Ukwishura Ivyiyumviro, n’Ubuvuzi Bubandanya bwa NHS):
   • Mu Bwongereza**, ukwitwararika abantu kw’inama nkuru y’intara bisigura gupima (ubu biri hejuru y’amapawundi 23.250** mu Bwongereza) birengagiza rwose agaciro k’inzu y’umuryango igihe cose uwo bubabakanye, uwo bubabakanye, canke incuti yiwe afise imyaka 60 canke irenga (canke abandanya kubaho)
   • Imbere yo kwishura n'ideni ry'inzu y'abageze mu zabukuru yo mu Bwongereza, wama usaba isuzuma ry'inzego nyinshi ku NHS Continuing Healthcare (NHS CHC): nimba umugeze mu zabukuru afise "ivyipfuzo vy'ubuvuzi vy'intango" (ivy'ubuvuzi bikomeye, bikomeye, bitamenyekana), NHS itegerezwa kwishura amahera yose y'ubuvuzi n'ivy'ubuvuzi 100 kw'ijana ikigeragezo c’ubushobozi bw’amahera, ata kuraba amahera canke itunga uwo mukuru afise.

Ibibazo bikunda kubazwa¶

Mbega iyo nzu y’abageze mu zabukuru yoba yoshobora kunshinja (umwana akuze) ubwanje kubera amafaranga umuvyeyi wanje atarishe?¶

Nimba utigeze usinya amasezerano yo kwakira nk’umuntu yishingira amahera kandi utigeze wiba, uhisha canke ubika amahera y’umuvyeyi wawe bwite canke amasheki y’ubwishingizi bw’ubuzima, inzu y’abageze mu zabukuru muri rusangi ntishobora kugufata nk’uwufise uruhara ku bijanye n’amahera y’umuvyeyi wawe hakurikijwe itegeko rya Leta Zunze Ubumwe za Amerika (42 U.S.C. § 1396()r)i(c)i). Ariko rero, urabe neza cane imitego ibiri aho amazu y’abageze mu zabukuru Ashobora kurega neza abana bakuze: (1) iyo ufise uburenganzira bwo gutanga amafaranga (POA) ku muvyeyi wawe kandi ukananirwa gutanga sheki y’ukwezi y’ubwishingizi bw’ubuzima/pansiyo y’umuvyeyi wawe ku kigo canke ukananirwa gutanga amafaranga y’ubuvuzi, y'inshingano y'ukwizigira / ukurenga ku masezerano nk'Uwujejwe"; na (2) mu bihugu bikeyi bifise "Amategeko agenga inshingano z'abana" akora (cane cane Pennsylvania), inkiko rimwe na rimwe zarafashe abana bakuze kubazwa igihe babujije gusaba Medicaid canke bagahindura amahera y'umuvyeyi. Imisi yose usabe Medicaid vuba kandi wishyure umugabane w’umurwayi asabwa ku kwezi ku gihe.

Bimeze gute iyo umuvyeyi wanje ari mu nzu y’abageze mu zabukuru asanzwe afise indwara yo kwihebura iteye imbere kandi atigeze ashira umukono ku Gitabu c’Ububasha?¶

Iyo umuvyeyi wawe atagira ubushobozi bwo gutahura no gushira umukono ku gitabu c’ububasha bw’amahera (POA) kandi amakonti yabo yo muri banki, IRA, canke inyandiko y’inzu ikaba yanditswe mw’izina ryiwe gusa, amabanki azokwanka kuguha uburenganzira bwo kwinjira kuri konti zabo kugira ngo ukoranirize hamwe amakuru y’imyaka 5 yo gusubira inyuma canke gukora igikorwa co gukoresha amahera. Mbere, menya ko umuntu wese afasha umukuze ashobora gusinya no gutanga urupapuro rwa mbere rwo gusaba Medicaid ubwiwe nk’Umuserukira yemerewe gufunga mu kwezi kwo gutanga, kandi ibisata vya leta vya Medicaid birafise ububasha bwo gusaba amafaranga yo muri banki ataco bimaze biciye ku nzira yo kugenzura umutungo (AVS) iyo umenyesheje uwusaba mu nyandiko ko umukozi w’urubanza ari mu nyandiko. Ubwa kabiri, kugira ngo mu vy’ukuri ushobore kuronka no gukoresha amakonti ya banki yafunzwe, uzokenera gutanga ikirego c’ivyihutirwa mu ntara yawe mu Rukiko rw’Igihugu rwerekeye **Ukubungabunga / Ubucungezi bw’Itunga** (canke gusaba itegeko ry’uburinzi ry’urukiko rw’ibikorwa bimwe ry’ugukingira uwo mwubakanye afise ubumuga).

Mbega Medicaid yoba isubira inyuma igafata amasheki y’umuvyeyi y’ubwishingizi bw’ubuzima y’imyaka 5 iheze?¶

Oya, Igihe c’imyaka 5 (amezi 60) co gusubira inyuma c’ubuvuzi bwa Medicaid ntigisubiza inyuma amahera umuvyeyi wawe yakoresheje mu buryo bubereye mu vyo akoresha mu buzima bwiwe bwite, ubukode, ibifungurwa, amafaranga y’amazi, abafasha kwitaho mu rugo, imisoro, canke ibiruhuko mu myaka itanu iheze. Igenzura ry’imyaka 5 rirondera gusa **ingabirano zitarishwe canke amahera yimuriwe ku giciro kiri munsi y’agaciro k’isoko** (nk’ukwandika sheki y’amadolari 10.000 ku mwuzukuru canke gutanga inzu y’ibarabara ku madolari zero). Igihe cose amahera y’umuvyeyi wawe yakoreshejwe mu gucuruza ibintu no mu bikorwa vy’umuvyeyi wawe (canke uwo bubabakanye), ayo mahera arakoreshwa ni ay’amategeko 100 kw’ijana. Ariko rero, wirinde gukura amafaranga menshi cane yo muri ATM kugira ngo wishyure abajejwe kwitwararika abana batari mu buryo busanzwe "munsi y'imeza" ata **Isezerano ryo kwitwararika umuntu** ryanditse n'inyandiko, kuko Medicaid ifata amafaranga akuwe ata nyandiko nk'ingabirano zitagenzuwe.

Twoba dukwiye gutana mu buryo butegekanijwe n’amategeko kugira ngo uwo twubakanye afise amagara meza ashobore kuguma afise amahera yose twazigamye?¶

Mu bihe vyinshi, kuronka "ukwahukana kwa Medicaid" ntibikenewe rwose kandi kenshi bisiga uwo bubabakanye afise amagara meza ari mu bibazo bibi kuruta kuguma yubatse no gukoresha ibikoresho vya Leta Zunze Ubumwe za Amerika vyo gukingira uwo bubabakanye. Iyo uhukanye, uratakaza uburenganzira bwo kuragwa inyungu y’ubwishingizi bw’ubuzima bw’uwo mwubakanye yapfuye iyo wubatse utarashika ku myaka 10, kandi amashirahamwe ya Medicaid arakunda guhangana n’uburenganzira bwo gutana. Ahubwo, kuguma wubatse no gukoresha umuvugizi w’abakurambere yemewe (CELA) kugira ngo ushire hamwe inzu isonewe, amadolari 154.140 CSRA, n’Itegeko ry’Ugufasha ry’Umwaka canke ry’Urukiko ry’Igihugu ryubahiriza Medicaid, mu bisanzwe birinda 90 gushika ku 100 kw’ijana vy’ugusenyuka kw’ubuzima bwawe.

Amasoko yasuzumwe¶

• Itegeko rya Leta Zunze Ubumwe za Amerika n’Ibibanza vy’Ibikorwa vy’Ubuvuzi n’Ivy’Ubuvuzi (CMS, Leta Zunze Ubumwe za Amerika): 42 U.S.C. § 1396r-5 (Ugufata inyungu n’itunga ry’ababiranye bamwebamwe bari mu nzego / Ivyiyumviro vy’ubukene bw’ababiranye: CSRA na MMMNA) na 42 U.S.C. § 1396p (Ivy’ugufata, Ivy’uguhindura, Ivy’ugusubiza ivy’umutungo, Ivy’ugusubira inyuma vy’amezi 60, Gusonerwa kw’umwana w’umuvyeyi, n’Ivyinjira bikwiye / Miller Trusts).
• Itegeko ry’Igihugu ryerekeye Ivugurura ry’Inzu z’Abageze mu zabukuru (OBRA ’87, Leta Zunze Ubumwe za Amerika): 42 U.S.C. § 1396r©(5)(A)(ii) n’iya 42 C.F.R. § 483.15 (Ukubuza Gusaba Ingwati z'Imari z'Umuntu wa Gatatu ku Kwemererwa no Kurinda Abaturage "Barindiriye Medicaid" Kugira ngo Ntibirukanwe).
• Ubuyobozi bw’Umutekano w’Igihugu (SSA, Leta Zunze Ubumwe za Amerika): Igitabo c’Ibikorwa vya Porogarama (POMS) SI 01130.100 gushika kuri SI 01130.420 (Ibikoresho Bitarimwo: Imipaka y’Uburinganire bw’Icumbi ry’Imbere, Ikigega c’Imodoka Imwe, n’Ikigega Kidashobora Gusubirwamwo Buri.
• Ishure ry’Igihugu ry’Abavoka b’Abageze mu zabukuru (NAELA) n’Ijwi ry’Igihugu ry’Abaguzi ku bijanye n’Ukwitwararika Ivyiza vy’Igihe Kirekire (Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako zo Gukoresha Amahera y’Igihugu, Amasezerano y’Ukwitwararika Umuntu, n’Ukwikingira Imigenzo Yemewe yo Gukusanya Amahera mu Ngo z’Abageze mu zabukuru.
• Igisata c’ubuzima n’imibereho myiza y’abantu na NHS Ubwongereza (Ubwongereza): Itegeko ryerekeye ubuvuzi ryo mu 2014 Inyigisho z’Itegeko (Umugereka B: Gufata umutungo n’ugusuzugura aho ababiranye n’incuti zabo bafise imyaka 60+ baba) na *Igihugu c’ubuvuzi bukomeza muri NHS ( CHSNHC)Care.

Inyobora zifitaniye isano¶

• Guhohoterwa mu nzu y'abageze mu zabukuru, gusuzugurwa, no kwiregura mu kwirukanwa
• Guhangana n'ibitaro bitagira umutekano canke gusohoka mu bitaro
• Ugukoresha nabi amafaranga no kwikingira ubusuma
• Ibitaro vy'ubujuju n'ubuvugizi bw'ubuvuzi ku bakuze
• Ubumuga butunguranye bw'uwurera abana n'ugutabara kw'abakuze
• Inomero z'ivyihutirwa