Top Puerto Rico officials are pushing for increased federal funds to boost their fragile Medicaid program after Hurricane Fiona ripped through the island last month. The asks come from Gov. Pedro Pierluisi (D) and Rep. Jenniffer González-Colón (R), each of whom recently sent congressional leaders separate letters obtained by The Health 202. Some of the requests are similar to funding lawmakers approved after Hurricane Maria devastated the island and put pressure on its medical system in 2017. The demands for more cash underscore concerns that the recent hurricane could have a sustained impact on the island’s health-care safety net. And it highlights the complex financing mechanism for Puerto Rico’s Medicaid program, which officials and experts say has long been underfunded. The storm wreaked havoc when it made landfall last month, causing severe flooding and knocking out power for more than 3 million residents. Much of the power has since been restored, and 99 percent of Level 1 hospitals are back on the electrical grid after running on generators. But the recovery efforts will take time — a reality President Biden alluded to when he told Puerto Ricans he was “committed to this island” in a visit to the territory earlier this week.
Here’s the gist:
In the states: There isn’t a limit on the cash the federal government can put toward states’ Medicaid programs. But such a limit exists for the territories. There’s a cap on the amount of money the territories’ Medicaid programs can receive from the federal government each year. Congress has some discretion here. Lawmakers typically boost the floor for how much the federal government must match the territories’ Medicaid dollars. They also usually raise the cap on how much federal funds the safety net gets each year.
Currently, the island receives a 76 percent match from the federal government on its Medicaid dollars. Puerto Rico now must receive at least $2.9 billion in total from the feds each year, the result of a recent Biden administration increase. (Read more on how a government watchdog says such a move was wrong.)
PLEAS FOR MORE CASH
Top island officials say they were already anticipating a funding shortfall for its Medicaid program this year. Carmen Feliciano, the executive director of the Puerto Rico Federal Affairs Administration, said the government had estimated the deficit would amount to $400 million — and that was before Hurricane Fiona hit. Now, they’re requesting more dollars from Congress. Pierluisi, the governor, is asking congressional leadership for any potential disaster relief bill to include five immediate needs for the island. Topping the list: More Medicaid dollars.
The request consists of a temporary 100 percent match in federal funds, an additional $400 million through the end of the year and the continuation of $200 million to boost provider payment rates, according to a Sept. 26 letter obtained by The Health 202. “This is very short term,” Feliciano said, adding Puerto Rico officials are seeking a long-term fix to the island’s complex Medicaid funding structure.
González-Colón, who’s a nonvoting member of Congress, sent specific funding asks to congressional leaders for the next seven years in a letter obtained by The Health 202.
For the next two fiscal years: She also requested a 100 percent match from the federal government — which Congress signed off on after Hurricane Maria — as well as raising the cap to $5 billion each year. From fiscal year 2025 to fiscal year 2030: The congresswoman asked for a federal matching rate of 83 percent, as well as a $21.5 billion cap in total. This could help the government pay for services it typically can’t cover, like non-emergency transport and adult vaccinations, she wrote.
In an interview, González-Colón also stressed that she’s seeking a permanent solution to the frequent funding cliffs facing the island. “Resolving this permanently, or at least [for] five to seven years with the funding, will allow the island to stabilize.” Capitol Hill will soon contend with Medicaid funding for the island. The current federal match rate for all U.S. territories is set to revert back to a lower threshold in mid-December, meaning congressional leaders will be soon faced with decisions over how much money to give Puerto Rico no matter what. In a statement, Rep. Frank Pallone (D-N.J.) — the chair of the powerful House panel overseeing Medicaid — said he’s “reviewing Puerto Rico’s funding request and I look forward to working with congressional leaders to ensure they have the resources and support they need.”
