In light of the fear that thousands of Puerto Ricans will be left without health coverage for the month of October.
By: NotiCel Published: Mar 30, 2021 03:00 PMUpdated: Mar 30, 2021 03:08 PM https://www.noticel.com/gobierno/ahora/20210330/gobernador-crea-grupo-de-trabajo-multisectorial-para-pedir-trato-igual-en-fondos-medicare-y-medicaid/
Given the need to achieve equal treatment in funding for federal Medicaid and Medicare programs, Puerto Rico Governor Pedro R. Pierluisi today created through Executive Order 2021-025 a Multisectoral Working Group that will prepare proposals and work strategies before Congress and the federal Executive Branch.
According to a press release, the action seeks to prevent thousands of Puerto Ricans from being left without health coverage starting in October of this year.
The multi-sectoral group, which will be chaired by Health Secretary Dr. Carlos Mellado and co-chaired by the executive director of the Federal Affairs Administration (PRFAA), Carmen Feliciano, will work in coordination with the governor and key components of the health sector. It will be integrated by the resident commissioner in Washington, Jennifer González Colón, the executive director of the Health Insurance Administration (ASES) Jorge Galva and the executive director of the Financial Advisory Authority and Fiscal Agency (AAFAF) Omar Marrero.
The Hospital Association, the Puerto Rico College of Surgeons, the Puerto Rico Medicaid & Medicare Advantage Products Association (MMAPA), the Independent Practice Association (IPA) and the Community Pharmacy Association will also be part of the Task Force. The Task Force will also have three additional members appointed by the Governor.
"There is no doubt that the economic crisis, the devastation caused by the passage of Hurricanes Irma and Maria and the Covid 19 pandemic have affected the infrastructure of the health care system and have caused an exodus of health care providers. If the flow of federal funds to Puerto Rico decreases, Puerto Rican patients will have fewer benefits and the government will not have enough resources to provide adequate health services. Likewise, this will impact providers," the governor said in written statements, after stressing that if Puerto Rico is to receive "fair and equitable treatment" in Medicaid, it is "essential" that new benefits be added to the coverage.
In the Executive Order, Pierluisi explained that Puerto Rico, being a territory of the United States, does not receive federal funding parity for the Medicaid and Medicare health programs, as compared to the states and the District of Columbia. In the case of Medicaid, states receive federal funds at a federal rate called the Federal Medical Assistance Percentage (FMAP), which varies according to state per capita income. However, the federal funds that Puerto Rico receives are significantly less, with a cap and a fixed rate, which is lower than the rate it would receive if it were a state.
"This inequity in federal funds causes the Puerto Rico government to have to defray a large part of the cost of the Government Health Plan, known as the Vital Plan, with state funds," Pierluisi said.
With the passage of the Further Consolidated Appropriations Act (PL 116-94), Congress granted a temporary increase in the Medicaid funding cap for the Vital Plan of $2,623,188,000 for federal fiscal year 2020 and $2,719,072,000 for fiscal year 2021. This represents an increase of $95,884,000. On the other hand, through the Families First Coronavirus Response Act (PL 116-27), the Medicaid funding cap was temporarily increased to $2,716,188,000 for FY 2020 and $2,809,063,000 for FY 2021 for a difference of $92,875,000.
However, currently, thousands of Puerto Ricans, who would be income-eligible for Medicaid benefits in any state, do not qualify for such benefits because of the inequity in the Poverty Level Ratio that the federal government applies to Puerto Rico.
It is clear from the Executive Order that there are critical measures that have been worked on to increase Medicaid program eligibility, benefit improvements and provider compensation (doctors and hospitals), but the temporary nature of this appropriation of funds, which ends on September 30, 2021, has the effect of placing Puerto Rico once again at the potential risk of a fiscal cliff in Medicaid funding for fiscal year 2022, which begins on October 1, 2021, and for subsequent years. As a result, thousands of Puerto Ricans could lose their health coverage.
The Multi-Sector Working Group is expected to provide the Governor with an initial report in 30 days on possible strategies to impact federal public policy and achieve parity in Medicaid and Medicare funding.