Monday, October 18, 2021

Gov. Pierluisi Urges Congress to Give Puerto Rico State-Like Treatment in Medicaid

By on March 10, 2021

SAN JUAN – Gov. Pedro Pierluisi sent a letter Tuesday to the leaders of the U.S. Congress and the chairmen and ranking members of the Senate Finance and House Ways and Means committees urging them to fully fund Puerto Rico’s Medicaid program.

In the letter, the governor forewarns that without continued federal funding, the island will face a Medicaid fiscal cliff on Sept. 30. Puerto Rico’s Medicaid program serves more than 1.4 million beneficiaries providing access to health care for some of the most vulnerable populations on the island, including low-income families, children and individuals with disabilities.

A release issued by the Puerto Rico Federal Affairs Administration (PRFAA) explains that, in 2019, Puerto Rico’s Medicaid program received $2.6 billion for fiscal year (FY) 2020 and $2.7 billion for FY 2021 at an increased Federal Medical Assistance Percentage (FMAP) of 76 percent, plus $200 million subject to compliance with certain requirements. This funding was further increased by the Families First Coronavirus Response Act with an additional $2.7 billion for FY 2020 and $2.8 billion for FY 2021, with a temporary increase of 6.2 percentage points on a quarterly basis during the term of the emergency period of COVID-19.

“I will continue to advocate for the equal treatment of Puerto Rico’s Medicaid program by promoting the transition of federal funding for Puerto Rico to a state-like program instead of a statutorily capped blocked grant, and an FMAP based on Puerto Rico’s per capita income relative to that of the Nation,” Pierluisi stated.

“I will fight to ensure that we are able to attain adequate long-term funding to provide the life-saving services patients require to meet their medical needs and to retain medical specialists by providing competitive reimbursements. Without proper federal funding, there will be a reduction of health care services exacerbating the ongoing medical crisis. I look forward to having conversations with congressional leadership and committees of jurisdiction to meet the health care needs of vulnerable U.S. citizens in Puerto Rico,” the governor added.

“Puerto Rico once again will face a Medicaid cliff on September 30, 2021, and it is imperative that adequate federal funding is provided to the program so that the American citizens residing in Puerto Rico can have access to the same healthcare services as their counterparts in the mainland. We urge Congress to act promptly on a long-term fix for Puerto Rico’s Medicaid program and look forward to continuing working with leadership and the committees of jurisdiction on this issue of utmost importance to our island,” PRFAA Executive Director Carmen M. Feliciano added.  

Pierluisi’s letter to congressional leadership follows:

GOVERNOR OF PUERTO RICO 

Pedro R. Pierluisi 

March 5, 2021 

The Honorable Nancy Pelosi Speaker U.S. House of Representatives H-232, The Capitol Washington, D.C. 20515 

The Honorable Charles Schumer Majority Leader 

U.S. Senate S-230, The Capitol Washington, D.C. 20510 

The Honorable Mitch McConnell Republican Leader U.S. Senate S-221, The Capitol Washington, D.C. 20510 

The Honorable Kevin McCarthy Republican Leader U.S. House of Representatives H-204, The Capitol Washington, D.C. 20515 

Dear Speaker Pelosi, Majority Leader Schumer, Republican Leader McConnell, and Republican Leader McCarthy: 

I write to thank you and ask for your continued support of adequate federal funding for Puerto Rico’s Medicaid program. The impacts of the COVID-19 pandemic have demonstrated the need for health care accessibility and a robust Medicaid program to address the medical needs of the most vulnerable in our society. However, without continued federal funding of Puerto Rico’s Medicaid program, the island is facing a fiscal cliff on September 30, 2021. 

Medicaid is designed to treat our nation’s most vulnerable populations, including low-income families, the elderly, children, and individuals with disabilities. The U.S. citizens of Puerto Rico suffer from serious health conditions that require urgent care, including mental health issues and chronic diseases such as cancer diabetes, Hepatitis C, and HIV. Unfortunately, the COVID-19 pandemic has only exacerbated the challenges to these illnesses. 

As you are aware the Further Consolidated Appropriations Act, 2020 (P.L. 116-94), provided Puerto Rico and the other U.S. territories an increase in Section 1108(g) of the Social Security Act (SSA) capped funds and an increase in the Federal 

Medical Assistance Percentage (FMAP). Puerto Rico was appropriated increased capped funding of $2.6 billion for fiscal year (FY) 2020, and $2.7 billion for FY 2021, at an increased FMAP of 76 percent. The increased capped funding for FY 2020 and FY 2021 respectively, were also subject to a potential annual increase of $200 million, if the Secretary of Health and Human Services (HHS) certified that Puerto Rico established a reimbursement floor, implemented through a directed payment arrangement plan, for physician services covered under Medicare Part B at a rate not less than 70 percent. Furthermore, the Families First Coronavirus Response Act (P.L. 116-127) increased Puerto Rico’s capped funding to $2.7 billion for FY 2020 and $2.8 billion for FY 2021 with a temporary increase in the FMAP of 6.2 percentage points on a quarterly basis during the term of the emergency period. 

Unfortunately, due to COVID-19’s numerous unforeseen disturbances to health care facilities and bureaucratic delays, the Government of Puerto Rico was unable to obligate the totality of the $2.9 billion appropriated for FY 2020. The main reason for the Government’s inability to use the entirety of the FY 2020 funds, was due to the denial by the Financial Oversight and Management Board (FOMB) of Puerto Rico to implement the Puerto Rico Poverty Level (PRPL) initiative that would have resulted in an estimated additional 200,000 new beneficiaries joining Puerto Rico’s Medicaid program in 2020. The FOMB denied the implementation of the initiative because the appropriated federal funding for Puerto Rico’s Medicaid program was only for two years. In accordance with PROMESA (P.L. 114-187), the FOMB did not want to approve a program with new beneficiaries that would face a fiscal cliff. 

However, due to the efforts of my predecessor, the Puerto Rico Department of Health (PRDOH), the Puerto Rico Health Insurance Administration (ASES, by its Spanish acronym), and the Puerto Rico Federal Affairs Administration (PRFAA), the Government of Puerto Rico was able to negotiate with the FOMB to find a solution. On October 16, 2020, the FOMB approved the Government of Puerto Rico’s petition to temporarily expand Medicaid coverage under the Vital Plan to more than 200,000 new beneficiaries due to the gravity of the COVID-19 pandemic, On December 11, 2020, the Centers for Medicare and Medicaid Services (CMS) approved the Vital Plan. 

Authorizing the entirety of FY 2021 federal Medicaid funding permits the Government of Puerto Rico to temporarily provide health care coverage during the COVID-19 public health emergency to an estimated 200,000 additional  vulnerable Medicaid beneficiaries. Full usage of federal Medicaid funds will also help with the retainment of doctors and specialist on the island, by increasing payment rates to match 70 percent of what a doctor would earn serving Medicaid patients in the 50 states. 

Nonetheless, federal funding for Puerto Rico’s Medicaid program is facing a fiscal cliff on September 30, 2021. Therefore, I will continue to advocate for the equal treatment of Puerto Rico’s Medicaid program by promoting the transition of federal funding for Puerto Rico to a state-like program instead of a statutorily capped block grant, and an FMAP based on Puerto Rico’s per capita income relative to that of the nation. I will fight to ensure that we are able to attain adequate long-term funding to provide the life-saving services patients require to meet their medical needs, and to retain medical specialists by providing competitive reimbursements. Without proper federal funding, there will be a reduction of health care services exacerbating the ongoing medical crisis. Thus, look forward to having conversations with Congressional leadership and committees of jurisdiction to meet the health care needs of vulnerable U.S. citizens in Puerto Rico. 

I thank you in advance for your support and I look forward to our future collaboration. If you require additional information or have any questions, please do not hesitate to contact me or Carmen Feliciano, Esq., Executive Director of the Puerto Rico Federal Affairs Administration, at (202) 778-0710 or via email at cfeliciano@prfaa.pr.gov. 

Sincerely, 

CC: 

The Honorable Ron Wyden, Chairman, U.S. Senate Committee on Finance The Honorable Michael D. Crapo, Ranking Member, U.S. Senate Committee on Finance The Honorable Frank Pallone, Chairman, U.S. House Committee on Energy and Commerce The Honorable Cathy McMorris Rodgers, Ranking Member, U.S. House Committee on Energy and Commerce The Honorable Jenniffer Gonzalez-Colón (PR-At-Large) La Fortaleza, San Juan, PR 00901 PO Box 9020082, San Juan, PR 00902-0082 787.721.7000

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