Letter to the Hon. Paul D. Ryan, Speaker of the U.S. House of Representatives - In Wake of Fiscal Crisis, Members Urge Congress to Extend Medicaid Grant in Puerto Rico

Letter

Dear Speaker Ryan:

We write to urge immediate congressional action to address the funding crisis facing Puerto Rico's health care system. As you know, Puerto Rico's Medicaid program receives a lower reimbursement rate than mainland states. This low rate is being temporarily supplemented by a federal grant that expires soon. Based on projections provided by the Centers for Medicare and Medicaid Services, the island's supplemental funding will be depleted by the end of this year.

The Medicaid program is already experiencing cash flow problems. Congress' failure to address this funding gap will not only exacerbate Puerto Rico's already fragile fiscal condition but will deny health care coverage to nearly 1 million residents on the island. Not addressing the cliff will also result in additional outmigration to the mainland, where the cost of providing Medicaid is much greater than on the island. We have already seen unprecedented numbers of Puerto Rican residents, including health care providers, leave the island.

The Puerto Rican Task Force established by PROMESA reached bipartisan consensus in support of fiscally-responsible legislation to address the impending Medicaid cliff. Enacting such legislation immediately is essential to provide Puerto Rico's Medicaid agency with the certainty it needs to engage with the managed care organizations that operate the island's Medicaid program. While we believe that a long-term solution for Puerto Rico's historically inadequate federal Medicaid funding is long overdue, we want to stress our support for an immediate short-term solution to ensure full fiscal year financing for 2018 to avoid the Medicaid cliff. It is time for Congress to act -- and act soon -- as Puerto Ricans have suffered far too long.

We are gravely concerned about the implications of the cliff and, for this reason, believe that it must have Congress' full attention. The risks are too great to wait. Therefore, we urge you to make Medicaid funding for Puerto Rico a top priority and promptly bring legislation to the House floor as soon as possible.