Puerto Rico Gov. Pedro Pierluisi is in Washington, D.C., on Tuesday to advocate for the American territory to achieve parity in federal funding for Medicaid, a cornerstone goal of his administration that he is trying to push in a Democratic-controlled Congress.
“Puerto Rico should have state-like treatment on the Island’s Medicaid program; anything less than that is discrimination against the most vulnerable citizens of our Island based on their geographic location,” the governor said.
Medicaid is a joint federal-state program that offers 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 U.S. states do, resulting in less federal money for Medicaid than a state such as Mississippi, the poorest state in the union, which has a lower poverty rate and smaller population than the island.
“Without a permanent and reliable source of funding, Puerto Rico will not be able to provide much-needed services to its vulnerable low-income population,” the governor wrote.
Puerto Rico receives base financing through an annual block grant that has hovered between $360 million and $380 million in recent years, but that money has an annual cap and doesn’t cover all of Puerto Rico’s Medicaid expenditures.
“It is not nearly enough to cover what would be a complete Medicaid program in Puerto Rico,” said Javier Balmaceda, a senior policy analyst at the Center on Budget and Policy Priorities. “The cap is set in an arbitrary form, and the logic of the financing has budget reasons, but also discriminatory principles.”
To make up for the gap in funding, Congress has approved supplementary financing every few years by rolling the money into assorted fiscal packages. Most recently, the island received an additional $5.3 billion in 2019 for a two-year period.
Puerto Rican officials expect that the money — set to run out in September — will be replenished, but say the looming deficit is proof the island needs a different funding structure. The island’s residents would suffer greatly without the extra assistance, they say. Not having the money could result in limited programming, interruptions in lifesaving services, and hundreds of thousands of people losing coverage. There could also be cuts to other services the island government provides.
“Puerto Rico will have to put a lot of money over the [block grant] out of its own pocket,” said Balmaceda.
Pierluisi is requesting that Puerto Rico receive $5.2 billion to operate the federal health program for the 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 looking for what he dubs a “long-term solution” to the island’s Medicaid woes, acknowledging that recent increases in supplementary funding have been beneficial for Puerto Ricans on the program, but do not solve its fiscal uncertainty.
The governor also supports eliminating the annual ceilings. He also proposes that the percentage the federal government contributes, known as the Federal Medical Assistance Percentage, or FMAP, be determined through the same formula used for states, which looks at per capita income, and results in poorer states paying less for Medicaid. As it stands, the share that the federal government pays to Puerto Rico on Medicaid is capped at 55%, although due to a combination of policies, including pandemic relief, the island’s FMAP is temporarily over 80%.
President Joe Biden has publicly supported eliminating 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’ve 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, the Department of Justice under Biden has continued to defend the federal government in United States v. Vaello-Madero, a Supreme Court case that is evaluating whether it is constitutional that residents of Puerto Rico are excluded from receiving Supplemental Security Income. The president has said it’s the DOJ’s duty to defend federal statutes, even if his administration does not agree with it.