By Jaime R. Torres, Opinion Contributor — 02/06/18
The Hill

The islands of Puerto Rico and the U.S. Virgin Islands are still recovering from the historic destruction caused by Hurricanes’ Irma and Maria. But it gets worst. As The Hill’s Nathaniel Weixel warned us in October, “Puerto Rico is facing an imminent Medicaid funding crisis, putting nearly 1 million people at risk of losing their health-care coverage.” Time is running out quickly: that crisis will happen as early as April 2018 when the onetime grant of $6.3 billion that Puerto Rico received, thanks to the Affordable Care Act, will run out.

How can this be? Puerto Rico and U.S. Virgin Islands are U.S. territories ruled by discriminatory, archaic and unacceptable Medicaid rules that, unlike the states, limit the federal funding they receive to cover these U.S. citizens — a fixed amount of funding that falls well below their actual Medicaid costs. …

Puerto Rico, for example, covers 1.6 million residents through its Medicaid program at a cost of $2.8 billion a year. The U.S. Virgin Islands covers 23,000 residents at a cost of $44 to $46 million per year. If either territory were a state, the federal Medicaid reimbursement would cover most of it, but because of unequal regulations we are facing this man-made, unavoidable crisis.

First, the reimbursement rate is unfair: For all states the Medicaid federal matching rates are based on their per capita income and poverty rates, while the territories, like Puerto Rico and the Virgin Islands, receive a fixed matching rate of 55 percent. As the Center on Budget and Policy Priorities has shown if Puerto Rico’s matching rate were set under the formula for states, it would be 83 percent.

Then, to add insult to injury, federal statute sets a cap limiting the annual Medicaid funding they receive. Puerto Rico can only receive $360 million and the Virgin Islands $18 million —that is it!

And due to Puerto Rico’s bankruptcy and the economic downturn after Hurricane Maria, it will be impossible for the local government to cover that immense shortfall. In fact Gov. Ricardo Rosselló announced that his new Fiscal Plan would a reduce $795 million for health care in the coming five years.

What can be done? Congress must act now and approve a temporary increase for two years to the federal Medicaid matching rate for Puerto Rico and the U.S. Virgin Islands to 100 percent, similar to what was done after Hurricane Katrina. Then after the end of the 24-month 100 percent match, maintain current levels of funding for Puerto Rico’s Medicaid program, at the current level of approximately $1.6 billion for a period of at least three years.

If Congress fails to act, 900,000 American citizens may lose Medicaid coverage in Puerto Rico, as determined by the U.S. Department of Health and Human Services last year.

Eventually only full funding and equal participation for all federal health programs will solve this crisis. It would help reduce further migration to the States and save the federal and state governments money in the long run. It costs 3-4 times more to treat a patient in a state like Florida than Puerto Rico. In fact, at current migration rates, it would cost the federal and state governments $4.2 billion in Medicaid and $1.7 billion in Medicare annually.

Congress needs to protect U.S. citizens still enduring the ravages of Hurricane Maria, and that is why these disparities should be addressed as part of the upcoming relief supplemental appropriations bill being considered now.

It is what they deserve. It is the right thing to do.

Dr. Jaime R. Torres is president of Latinos for Healthcare Equity, and the former regional director of the US Department of Health & Human Services, Region II—serving New York, New Jersey, Puerto Rico and the US Virgin Islands.

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