Letter to the Hon. Mitch McConnell, Senate Majority Leader, and the Hon. Chuck Schumer, Senate Minority Leader - Boost Medicaid Resources in Wake of Hurricanes

Letter

Dear Leader McConnell and Leader Schumer:

As Congress continues to work on disaster relief legislation to aid all disaster afflicted areas in 2017, we write to urge your support for policies that will bolster the territories' Medicaid programs and ensure that those impacted by Hurricanes Irma and Maria have access to the health coverage they need.

Our fellow Americans in Puerto Rico and the U.S. Virgin Islands are in their moments of greatest need as they recover from the devastation caused by Hurricanes Irma and Maria. Among the many challenges facing the territories are medical and public health concerns that range from managing chronic conditions, preventing the spread of disease, and supporting those experiencing mental health issues, like depression and post-traumatic stress disorder. As we continue to support investments in public health infrastructure, response, and surveillance, it is imperative that residents of Puerto Rico and the U.S. Virgin Islands also maintain access to Medicaid coverage and services.

Puerto Rico and the U.S. Virgin Islands have long experienced disparities in Medicaid funding as compared to the 50 states and D.C. For example, in the mainland, federal funding is open-ended, with the federal contribution ranging from 50 percent for wealthier states to 83 percent for the poorer states. In the territories, federal Medicaid funding is capped and the federal contribution is statutorily set at 55 percent--well below the rate the island would receive if its rate were calculated the same as in the states. This has led to funding challenges and shortfalls that have only been exacerbated in the aftermath of the hurricanes.

At a minimum, Congress must temporarily increase the federal matching rate for the territories' Medicaid programs from its current level of 55 percent to 100 percent. Puerto Rico and the U.S. Virgin Islands have limited ability to provide their share of the Medicaid funds needed to draw down federal dollars, and this action would temporarily relieve them of immense fiscal pressure. Providing additional federal support for the non-federal Medicaid share would also be consistent with congressional action following Hurricane Katrina.

Increasing the federal matching rate on its own is insufficient. Congress must also eliminate the cap on Medicaid funding for the territories in order to provide the islands with necessary relief to recover. Even with an increased federal matching rate, Puerto Rico and the U.S. Virgin Islands would not be able to access the funds necessary for their Medicaid programs once they reach the funding caps.

In addition, since the hurricanes made landfall, it is estimated that more than 140,000 individuals have left Puerto Rico alone, many joining their families in the states.[1] Therefore, Congress should work to ensure that those who are displaced to the states in the aftermath of the storms have access to Medicaid coverage. Similar to action taken following Hurricane Katrina, Congress should work to ensure that individuals displaced Americans from Puerto Rico and the U.S. Virgin Islands can access needed care and that providers are reimbursed accordingly.

Furthermore, we encourage Congress to support the implementation of a streamlined and abbreviated process to reduce barriers to Medicaid eligibility and enrollment for those impacted by the hurricanes. Many of the islands' residents have been displaced and may have lost their personal belongings, including the documents needed to apply for Medicaid coverage. Allowing for self-attestation or to delay redeterminations for Medicaid eligibility will go a long way to helping displaced individuals get back on their feet.

We appreciate your consideration and look forward to working with you on this important issue.

Sincerely,