Call for a permanent solution to the Medicaid issue in Puerto Rico

Faced with the possibility that the U.S. Congress will not include Puerto Rico in the Medicaid program, the executive director of the Puerto Rico Health Insurance Administration, Jorge Galva, and the president of the Colleges of Health Services Administrators (CASS), Efraín Piñero, called for a permanent solution for the medical plan.

CASS, which brings together 800 hospital administrators, held a round table with Galva with the objective of integrating itself into the strategies of Governor Pedro Pierluisi Urrutia and Resident Commissioner Jenniffer González Colón in the federal capital to demand equal funding for the Medicaid program.

"We have had a discriminatory treatment of inferiority, my exhortation is to support this effort. All government and private entities, Medicare Advantage, among others, must join this effort. The Medicaid program is facing a fiscal cliff," Galva said in written statements.

Unlike the states, the Medicaid program in Puerto Rico has traditionally operated with a budget cap of about $400 million in federal funds that are allocated to cover 55 percent of its expenses. The remainder, 45 percent, has been matched by the Government of Puerto Rico. This matching formula is officially called the Federal Percentage of Assistance for Medicaid (FMAP).

During the last two federal fiscal years of 2020 and 2021, appropriations increased by $2.6 billion and $2.7 billion, respectively, through the passage of H.R. 116-94. Similarly, the legislation changed the percentage of the FMAP. The Federal Government's share increased from 55 percent, as noted above, to 82.2 percent through passage of the law and another Centers for Medicare and Medicaid Services (CMS) measure.

But Galva stressed that reversing the program in Puerto Rico would culminate in the cancellation of the Vital plan for 200,000 new subscribers and another 400,000 beneficiaries who were covered before the government approved the budget increases. Similarly, the program would have to significantly reduce the reimbursements received by service providers. The budget requested by ASES for the next fiscal year is $3.9 billion, which could be reduced to $2.5 billion if the program is reversed.

Notably, President Joe Biden's budget for the next fiscal year included language that eliminates the appropriations cap and aligns the states' FAMP rate.

Now, the budget is in the hands of the U.S. Congress. "The fight is not close to being won. There is a long way to go with significant obstacles. We cannot let our guard down, now more than ever, all sectors must be united with the government to protect the more than 1.3 million beneficiaries of Plan Vital and the public health of Puerto Rico," said Galva.

For his part, Piñero stressed that the disparity in the Medicaid program in Puerto Rico is closely related to the working conditions of providers, the infrastructure of hospital systems, among other key components of the industry.

"If there were a reasonable amount on a permanent basis, all institutions could budget to avoid the flight of professionals. Puerto Rico is distinguished for training excellent health professionals, but attractive salaries must be offered," said Piñero, who emphasized that in the next few days he will have a series of meetings with the Resident Commissioner and the chairmen of the Senate and House Health Committees.

The president of the College, which represents some 800 professionals licensed and registered to administer health services in Puerto Rico, warned that reducing the program's budget could have dire consequences for both providers and beneficiaries. "This would affect the entire industry. There would not be enough funds for the health system to continue functioning. It continues with interim remedies without making a final decision," he said.

Governor Pierluisi established the Puerto Rico Multisectoral Health Cluster through Executive Order-2021-025 to advance the Island's health initiatives before Congress.