According to the director of the fiscal agency, the island government is not prepared to offer all the services of this program and therefore have access to all the financing.
Washington D.C. - The Fiscal Oversight Board (FOSB) is pushing in Congress for Puerto Rico to have "fair" or "equitable" treatment in accessing Medicaid funds, but does not believe the government is ready to be able to offer all the services that parity with the states would represent.
"There are a whole variety of (Medicaid) services that are mandatory on the mainland that are not mandatory in Puerto Rico. Does that mean we want them to be mandatory as well? No. I think the word (parity) is very political and doesn't get us to the heart of the debate. But yes, (we advocate for) equal treatment, long-term clarity on Medicaid. Absolutely," said JSF Executive Director Natalie Jaresko in an interview this week with El Nuevo Día.
President Joe Biden has called on Congress to move forward with legislation to move Puerto Rico toward parity in Medicaid, the program on which the island's government health plan and much of the industry depends. Biden has not proposed a specific amount.
Without new legislation, the allocation for the Medicaid program would drop on October 1 - when the new federal fiscal year begins - to about $400 million, compared to the up to $2.842 billion the Puerto Rico government has this federal fiscal year available to fund its health plan.
A few days ago, the chairman of the House Energy and Natural Resources Committee, Democrat Frank Pallone (N.J.), told El Nuevo Día that he supports the concept of Medicare parity in the case of Puerto Rico.
In a brief interview Tuesday, Pallone reiterated that ideally, Congress should do for Puerto Rico "what it does for the states" under the Medicaid program "for as long as possible."
But, in response to Jaresko's comments - which were made on Monday - Pallone said he cannot say with which Medicaid services the Puerto Rico government can comply. He also said he cannot guarantee what position most of its members will take.
As stated by Senate Finance Committee Chairman Ron Wyden (D-Ore.), Pallone indicated that it has not yet been determined whether the next allocation of Medicaid funds will go into the budget bill or other more comprehensive legislation.
The Senate Democratic majority is still considering moving forward with a second budget reconciliation bill that could pass with 51 votes - circumventing the 60-vote filibuster requirement - and bring together President Joe Biden's plans for infrastructure, job creation and family assistance programs. Including new Medicaid funding in such legislation could be the best short-term scenario for the island, although it could last for up to 10 years.
Bills are pending before Congress to give Puerto Rico equal access to the Medicaid program.
Also on the table is a measure by Puerto Rican Democrat Congresswoman Nydia Velázquez (N.Y.) that would allocate a total of $18.5 billion to cover five years of Medicaid appropriations to the island, before making parity effective.
Velazquez's legislation would increase Medicaid appropriations in FY 2022 to $3.35 billion, about $500 million above current funding.
It then proposes allocations of $3.55 billion (2023), $3.75 billion (2024), $4 billion (2025) and $4.2 billion (2026). Beginning in 2027, there would be no limit on the Island's access to Medicaid funds.
Jaresko - who is scheduled to meet with Congress and the Treasury this week - insisted that without the approval of a new allocation from the federal government, the JSF should not project the amount of funds the island will have through the Medicaid program.
Even with a commitment from congressional leadership, Jaresko maintained that "we would not be told how many mandated services are going to be required" in order to determine to keep the budget in balance.
"There are an infinite number of things Congress can do," Jaresko said, referring to lifting the cap on appropriations or changing the federal contribution for Medicaid service, which now by permanent law is 55% and Puerto Rico's government authorities would like to see raised to 83%, under legislation that would bring the island in line with U.S. states.
Hernández Montañez said that a potential new allocation of Medicaid funds could mean changes of between $700 million and $1 billion in the budget, an issue that he foresees will have to return to the Puerto Rico Legislature for discussion.