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Puerto Rico Gov Pleads for Medicare Advantage Funding

By on March 20, 2020

Gov. Wanda Vázquez (Juan J. Rodríguez/CB)

Urges U.S. Health Secretary, CMS Administrators to Treat Island Equally

SAN JUAN — Concerned about the island’s Medicare Advantage (MA) program, Puerto Rico Gov. Wanda Vázquez Garced sent a letter to Alex Azar II, the secretary of the U.S. Department of Health and Human Services (HHS); Seema Verma, the administrator of the Centers for Medicare & Medicaid Services (CMS); and Demetrios Kouzoukas, the principal deputy administrator and director of CMS.

She urged them to “identify ways to restore more equitable funding”—as phrased in a press release by the Puerto Rico Federal Affairs Administration (PRFAA)—for the Medicare Advantage (MA) program on the island for fiscal year 2021.

The program serves more than 585,000 seniors in Puerto Rico. The letter outlined several priorities of the government to address some of the short-term healthcare challenges facing the elderly population on the island.

In the letter, the government proposes changes to MA funding and urges CMS to use the period before the release of the Final Call Letter to “identify ways to restore a more equitable 2021 funding for Puerto Rico’s  MA program.”

The letter stressed that the island’s current payment rate stands at 42 percent below the U.S. national average, “below Hawaii (the lowest state in the nation) and the U.S. Virgin Islands,” the PRFAA added.

More than 40 percent of Puerto Rico’s residents, the PRFAA said in the announcing release, live below the poverty line, and the island has the highest participation of MA beneficiaries in the United States, at approximately 75 percent.

Additionally, 280,000 beneficiaries in Puerto Rico are “dually eligible” for Medicare and Medicaid, the PRFAA said. “However, the MA program in Puerto Rico has the lowest payment rate by far in the entire program and beneficiaries do not receive the same Part D Low-Income subsidies as citizens in the rest of the United States. Using the period prior to the release of the Final Call Letter would present an opportunity to help improve Puerto Rico’s healthcare system,” the agency assured.

“We urge Secretary Azar, Administrator Verma, and Deputy Administrator Kouzoukas to use this period prior to the release of the Final Call Letter to identify ways to make Puerto Rico’s Medicare Advantage Program more equitable. This would address in the short-term, several challenges of our healthcare system,” PRFAA Executive Director Jennifer M. Storipan said. “I believe our most senior citizens must have access to much-needed quality healthcare. We must take action to ensure the welfare of our seniors.”

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