EFE NewsSan Juan30 Mar 2021
The governor of Puerto Rico, Pedro Pierluisi, announced Tuesday the creation of the Multisectoral Working Group to demand equal treatment in funding for the federal Medicaid and Medicare programs and prevent thousands of Puerto Ricans from being left without health care coverage starting in October.
"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," Pierluisi said in a press release.
This will also impact providers, the governor said, noting that in order for Puerto Rico to receive "fair and equitable treatment" in Medicaid, it is "essential" that new benefits be added to the coverage.
Through Executive Order 2021-025, Pierluisi created the group, which will prepare proposals and work strategies before Congress and the federal Executive Branch, according to a press release.
The multi-sectoral group, which will be chaired by Health Secretary Carlos Mellado and co-chaired by Federal Affairs Administration Executive Director Carmen Feliciano, will work in coordination with the governor and key components of the health sector.
The group will also include the resident commissioner in Washington, Jennifer González; the executive director of the Health Insurance Administration, Jorge Galva; and the executive director of the Financial Advisory Authority and Fiscal Agency, Omar Marrero.
The Hospital Association, the Puerto Rico College of Medical Surgeons, the Puerto Rico Medicaid & Medicare Advantage Products Association, the Independent Practices Association and the Community Pharmacy Association will also be members.
The Task Force will also include three additional members appointed by the governor.
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.
In the Executive Order, Pierluisi explained that Puerto Rico, as a U.S. territory, does not receive parity in federal funding for the Medicaid and Medicare health programs, as compared to the states and the District of Columbia.
The Executive Order details that there are critical measures that have been worked on to increase Medicaid program eligibility, benefit improvements and provider (physician and hospital) compensation.
However, the temporary nature of this appropriation, 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.
In the case of Medicaid, states receive federal funds at a federal rate called the "Federal Medical Assistance Percentage" that 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 Government of Puerto Rico 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.
As explained by the governor, following passage of the Further Consolidated Appropriations Act, Congress granted a temporary increase in the cap on Medicaid funding for the Vital Plan of $2.623 billion for federal fiscal year 2020 and $2.719 billion for fiscal year 2021.
This represents an increase of US$95,884,000.
On the other hand, through the Families First Coronavirus Response Act, the Medicaid funding cap was temporarily increased to $2.716 billion for FY 2020 and $2.809 billion for FY 2021, a difference is $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 unequal Poverty Level Ratio that the federal government applies to Puerto Rico.