Puerto Rico included in federal budget measure
Island counting on continuing resolution to address health funding
SAN JUAN — As organizations and individuals from Puerto Rico’s public and private sectors lobby lawmakers in Washington, D.C., for an immediate injection of Medicaid funds as well as a longer-term solution, the president of the College of Physicians and Surgeons, Dr. Víctor Ramos, was expecting the island would be included in the continuing resolution (CR) to fund the first weeks of the new federal fiscal year, a development that occurred Wednesday evening.
Puerto Rico was included in the continuing resolution introduced by House Democrats, which, if passed, would keep the Medicaid matching ratio for the island at 100 percent until Nov. 21.
In a statement, Gov. Wanda Vázquez said: “Our efforts in the Federal Capital together with the Secretary of Health, Rafael Rodríguez, and other agency heads and the Resident Commissioner, Jenniffer González, paid off, given that in [the] visit [to Washington, D.C.] we were able to reestablish communication and the trust in this government. I hope that this resolution will be approved….”
“This will provide time to continue efforts to get a four-year assignment for the Medicaid program for Puerto Rico, for the benefit of thousands of Puerto Ricans,” the Health secretary added.
Ramos pointed out the prevailing issues. First, the $4.8 billion allocation that Puerto Rico received as part of the post-Hurricane María recovery package is set to run out sooner than projected, leaving the island again facing the possibility of a healthcare cliff. Secondly, the doctor stressed, was the matter of working on increasing the federal Medicaid matching rate, or Federal Medical Assistance Percentage (FMAP), for Puerto Rico.
“We are [holding meetings] both in the House and in the Senate, pushing two things: that we are included in the CR, which is the temporary extension until November 21, and the long-term bill. In the CR, we intend to maintain the government [allocation] as it is,” the physician said earlier Wednesday.
“Our argument is, since we are at 100 percent Medicaid financing then give me the same I have now or at least what I am asking for in the measure, which is an FMAP of 83 percent,” he added.
As a territory, Puerto Rico’s annual Medicaid funding is subject to a cap with a fixed FMAP of 55 percent. In contrast, states receive Medicaid funding on an open-ended basis, with an FMAP that varies based on state per capita income. However, the recovery package approved under the Bipartisan Budget Act of 2018, was of $4.8 billion, which Puerto Rico’s government used to cover 100 percent of its Vital health program.
If Puerto Rico was treated as a state, its FMAP would be the maximum allowable rate, 83 percent.
This would be the third healthcare cliff Puerto Rico has faced since 2016 despite continuous attempts to increase healthcare funding for the island. The latest one is a bill introduced by Florida Rep. Darren Soto and co-signed by Puerto Rico Resident Commissioner Jenniffer González, which seeks to have Puerto Rico’s FMAP raised to 83 percent.
Besides working toward a more permanent solution, González is also actively trying to include Puerto Rico in the continuing resolution Congress is looking to pass to avoid a showdown over immigration-related funding.
In her letter to the congressional leadership, the resident commissioner argued that Puerto Rico is about to start negotiations with providers, and uncertainty about whether the island will have sufficient funds could result in a reduction of an already shrinking healthcare provider pool.
González also argued that given the $222 million budget cut in healthcare the island’s Financial Oversight and Management Board expects, a lack of funds would force the local government “to cut benefits, and possibly beneficiaries.”
Although on Tuesday morning the resident commissioner had said in a Radio Isla interview that including Puerto Rico in the continuing resolution would be an “uphill” effort, Ramos indicated that it was González that told the doctors’ group of the potential inclusion.
“We don’t have the actual language in the agreement, but apparently it is included, the resident commissioner office informed me,” Ramos said, adding that he believed inclusion in the continuing resolution was more likely than in the long-term bill, especially because they see hesitance in the Senate.
Ramos, who is being accompanied by delegations of various Puerto Rico healthcare organizations, indicated that senators keep bringing up the issue of transparency and the arrests this summer of the head of the island’s Health Insurance Administration as well as contractors on charges related to fraud and misuse of federal funds.