Enniffer González Urges Congress to Allocate Medicaid Funds to Avoid Deficit in October

Press Release

The Resident Commissioner, Jenniffer González Colón, urged Congress to allocate the necessary funds so that the beneficiaries of the Vital plan in Puerto Rico, which is nourished by Medicaid funds, do not lack coverage and avoid a deficit in the next federal fiscal year beginning in October.

González Colón deposed before the Subcommittee on Health of the Energy and Commerce Committee of the House of Representatives where he advocated for equal treatment for Puerto Rico under the Medicaid program and highlighted the disadvantages, challenges and limited access to benefits of American citizens residing in the island.

In the virtual public hearing entitled: Avoiding a crisis: protecting access to health care in the territories of the United States, the representatives of the territories deposed: Jenniffer González Colón (Puerto Rico), Gregorio Kilili Camacho Sablan (Islas de Mariana del North), Aumua Amata Coleman Radewagen (American Samoa), Stacey E. Plaskett (Virgin Islands) and Michael FQ San Nicolas (Guam); Anne Schwartz, Ph.D. Executive Director of the Commission for Access to Medicaid and CHIP Payments and Carolyn Yocom of the Government Accountability Office (GAO).

The commissioner noted that, since the inception of the Medicaid program, its federal funding has never been on par with the particular needs of the territories; and it has not been related to the expenses necessary for its implementation, causing the territories to have to disburse an amount of funds for this program disproportionately greater than that of the states even than Washington.

"Congress has a moral obligation to eradicate these disparities and eliminate discrimination between American citizens in similar situations, the only difference being the zip code where they reside," said González Colón.

During 2019, the government of Puerto Rico appeared before Congress in search of additional funds to supplement the insufficient cap on federal Medicaid funding that, at that time, represented only 10% of the total cost of the program, which offers only 10 of the 17 mandatory benefits. In addition, it requested additional funds for certain "sustainability measures" that were essential for the continued operation of the program and for the implementation of various program integrity measures that Puerto Rico has been adopting and implementing successfully.

The total amount of these initiatives increased the cost of the Medicaid program in Puerto Rico from $ 2.8 billion annually to approximately $ 3.5 billion for federal fiscal years 2020 and 2021. This added to an increase in the FMAP from 55% to 76%, vastly increasing the federal share of program funding. The approximate total reimbursement breakdown, after the approval of the initiatives and the FMAP increase is:

$ 350 million to increase the eligibility poverty level from 40% to 85% of the federal poverty level. The additional funds provided by Congress allowed Puerto Rico to cover more than 200,000 additional beneficiaries with annual income of less than $ 20,000 for a family of four.

$ 140 million to increase Medicare Part B provider reimbursement to 70% of the current Medicare fee schedule.

$ 50 million to increase reimbursement to capitated physicians. Medicaid physician fees are low in Puerto Rico compared to states for certain services, including primary care and maternity. Income disparity has contributed to a continuing exodus of younger physicians, which has left the island with a further, shrinking physician workforce.

Only 4% of doctors in Puerto Rico are 35 years old or younger, compared to 24% in the states, according to data submitted to MACPAC, leaving the island at risk of further loss of doctors as senior doctors retire. Additional funds provided by Congress allowed Puerto Rico to increase reimbursements to physicians by $ 190 million, an essential action to help physicians bear the economic burden during the pandemic.

$ 106 million in hospital reimbursement increases to offset loss of care for Medicaid recipients. Hospitals in Puerto Rico are not eligible for Medicaid Disparate Hospital Share whose purpose is precisely to meet the losses caused by low Medicaid payments. Funds provided by Congress allowed Puerto Rico to increase reimbursements to hospitals above 90% of the Medicare Fee Schedule.

$ 38 million to cover oral hepatitis C medications.

The commissioner explained that after a detailed analysis of the cost of the measures, it was decided that the Medicare Part B premium payment could not be covered because it would have severely taken money away from other initiatives. To date, Puerto Rico is on track to spend the remaining $ 700 million of supplemental aid by the end of this fiscal year.

The additional funds to the Medicaid program in Puerto Rico contained in the Additional Allocations Act of 2020 expire on September 30, 2021. To which the commissioner warned that, as of October 1, 2021, the allocation to the Medicaid program of Puerto Rico will be limited to approximately $ 380,000,000, or 10% of the current total cost of the program.

"As the end of Puerto Rico's fiscal year rapidly approaches, Congress must act quickly to prevent the Medicaid program from suffering from underfunding. If this happens, it could upset the contractual negotiations with the health care organizations that provide services to Medicaid recipients, and it would cause the Fiscal Oversight Board to substantially cut the budget for this program. Therefore, I ask that we work in a bipartisan manner to provide the Medicaid program in Puerto Rico with enough funding, at an FMAP of 83%, to allow it a smooth transition to the next fiscal year, without cutting benefits, reducing payments to providers. or withdraw coverage for hundreds of thousands of current beneficiaries in the midst of this pandemic ",

The Government of Puerto Rico has estimated that it needs $ 4.8 billion for fiscal year 2022 and $ 5.1 billion for fiscal year 2023 to continue administering its Medicaid program. This increase would allow a greater degree of equity in crucial health programs on the Island; These would include:
* Medicare Part B premium purchase payments for dual eligible beneficiaries;
* Long-term care services and supports;
* Non-influenza vaccines for adults as recommended by CDC;
* Non-emergency transportation;
* Durable medical equipment and supplies for diabetes; and
* Increased funding for distressed hospitals and dentists.

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