Puerto Rico Gov. Pedro Pierluisi is in Washington D.C. on Tuesday to advocate for the U.S. territory to achieve parity in federal Medicaid funding, a key goal of his administration that he is trying to push through a Democratic-controlled Congress.
"Puerto Rico deserves to have state-like treatment in the Medicaid program, and anything less than that represents discrimination against our Island's most vulnerable citizens simply because of their geographic location," the governor said.
Medicaid is a joint federal-state program that provides health coverage for low-income individuals and families, including 1.4 million people in Puerto Rico. But Puerto Rico, along with other U.S. territories, has a different funding structure than the states, resulting in less federal money for Medicaid than a state like Mississippi, the poorest state in the union, which has a lower poverty rate and less population than the island.
Pierluisi is expected to meet with federal officials and attend congressional meetings. The trip follows a recent letter sent by the island's top official to legislative leadership. The letter, obtained by El Nuevo Herald, requests that they work with his administration to fund "state-like" treatment so that the island can have a more comprehensive and stable Medicaid program. In correspondence, he also attributed the high rate of chronic diseases in Puerto Rico to a decades-long lack of funding and infrastructure for health programs.
"Without a permanent and reliable funding source, Puerto Rico will not be able to provide much-needed services to its vulnerable low-income population," the governor wrote.
Puerto Rico receives base funding through an annual block grant that has ranged from $360 million to $380 million in recent years, but that money is capped annually and does not cover all of Puerto Rico's Medicaid expenditures.
"It doesn't come close to covering what a full Medicaid program would be in Puerto Rico," said Javier Balmaceda, senior policy analyst at the Center on Budget and Policy Priorities. "The rationale for that funding has budgetary principles, arbitrarily set, and also somewhat discriminatory cutting principles."
To make up for the funding gap, Congress has approved supplemental funds every few years through a variety of tax packages. Most recently, the island received an additional $5.3 billion in 2019 for a two-year period.
Puerto Rican officials hope the money-which will run out in September-will be replenished, but say the looming shortfall is proof that the island needs a different funding structure. Island residents would suffer greatly without the additional aid, they say. Not having the money could result in limited programming, disruptions in life-saving services and hundreds of thousands of people losing coverage. There could also be cuts in other services provided by the island government.
"Puerto Rico is going to have to put quite a bit of money over [that limit] out of its own pocket," Balmaceda said.
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Pierluisi is requesting that Puerto Rico receive $5.2 billion to operate the federal health care program by fiscal year 2022, compared to the $2.7 billion in additional federal money the local government has this year to run the program. He is also seeking what he calls a "long-term solution" for Medicaid on the island, acknowledging that recent increases in matching funds have been beneficial to Puerto Ricans in the program, but do not resolve its fiscal uncertainty.
The governor also supports the elimination of annual caps. He also proposes that the percentage contributed by the federal government, known as the Federal Medical Assistance Percentage, or FMAP, be determined by the same formula used for states, which analyzes per capita income and results in poorer states paying less for Medicaid. As it stands, the federal government's share of Medicaid payments to Puerto Rico is capped at 55%, although due to a combination of policies, including pandemic relief, the island's FMAP temporarily exceeds 80%.
President Joe Biden has publicly supported the elimination of Medicaid funding caps for Puerto Rico. He has also advocated for equal treatment with other federal welfare programs, such as Supplemental Security Income and Supplemental Nutrition Assistance.
"As I have said before, there can be no second-class citizens in the United States of America. My administration will work with members of Congress to make these legislative fixes a reality," the president said in a recent statement.
However, Biden's Justice Department has continued to defend the federal government in United States v. Vaello-Madero, a Supreme Court case that is evaluating whether it is constitutional for residents of Puerto Rico to be excluded from receiving Supplemental Security Income. The president has said it is the Justice Department's duty to defend federal statutes, even if his administration disagrees with them.
"I am confident that members of Congress will succeed in resolving the funding shortfall in our Medicaid program, and that they agree with me and President Biden that the best solution will be to extend equal treatment to Puerto Rico's Medicaid program," Pierluisi said.